Inclusion, exclusion and audit criteria — Delayed Investigations Impact Audit

Inclusion criteria

Locally adaptable in Project setup.

•Adults aged 16 years or older unless locally adapted.
•Adult inpatient, assessment unit, ED, SDEC or ambulatory episodes where an investigation was requested or should reasonably have been requested.
•Cases where an investigation delay occurred or may have affected diagnosis, treatment, discharge or safety.
•Cases where delayed investigation review or delayed action on results occurred.
•Imaging, pathology, microbiology, endoscopy, physiology, specialist diagnostic tests or other locally relevant investigations.
•Patients managed in selected wards, units, departments or pathways.
•Electronic, paper or hybrid records depending on local setup.

Exclusion criteria

Episodes outside the scope of this audit cycle.

•Patients under 16 years old unless locally adapted.
•Maternity-specific investigation pathways unless locally adapted.
•Outpatient-only diagnostic waiting-list audits unless local scope includes them.
•Planned elective investigations not related to an acute admission unless locally included.
•Investigations not clinically indicated or cancelled for appropriate clinical reasons.
•Cases where delay was entirely outside the organisation's remit and local scope excludes external delays.
•Duplicate records or duplicate investigation delay episodes.
•Records outside the selected audit period.
•Records unavailable for review.
•Cases where local governance approval is required but has not been obtained.
•Direct patient identifiers entered into the tool.

Audit standards

Default local standards. Adjust the local target in Project setup where your organisation uses a different threshold.

•At least 90% of relevant investigation episodes should have the clinical indication documented.
•At least 90% should have urgency or priority documented where required.
•At least 90% should have the investigation requested within the locally expected timeframe.
•At least 90% should have the investigation completed within the locally expected timeframe where inpatient completion is required.
•At least 90% should have results reviewed within the locally expected timeframe.
•At least 90% should have abnormal or clinically significant results actioned or escalated where required.
•At least 90% of delayed investigations should have delay reason documented.
•At least 90% of delay episodes affecting discharge should have action owner, next action and discharge impact documented.
•At least 90% should have outpatient / planned return options considered where safe and appropriate.
•At least 90% should have delayed-investigation-related safety concerns escalated or actioned where identified.

Audit criteria (28)

Each criterion is recorded as Yes, No, Not applicable or Unable to determine. Compliance is calculated from Yes and No responses only.

1
Clinical indication for the investigation was documented.
Local standard ≥ 90%
2
Investigation urgency or priority was documented.
Local standard ≥ 90%
3
Investigation was requested within the locally expected timeframe after it became clinically indicated.
Local standard ≥ 90%
4
Investigation request was complete and suitable for acceptance, vetting or scheduling.
Local standard ≥ 90%
5
Investigation was accepted, vetted, triaged or protocolled within local expected timeframe where required.
Local standard ≥ 90%
6
Investigation was performed or sample was taken within the locally expected timeframe.
Local standard ≥ 90%
7
Result was available within the locally expected timeframe.
Local standard ≥ 90%
8
Result was reviewed by the clinical team within the locally expected timeframe.
Local standard ≥ 90%
9
Result was actioned within the locally expected timeframe where action was required.
Local standard ≥ 90%
10
Abnormal or clinically significant result was escalated where required.
Local standard ≥ 90%
11
Delay stage was identifiable from the record.
Local standard ≥ 90%
12
Reason for delay was documented where applicable.
Local standard ≥ 90%
13
Interim clinical management plan was documented while awaiting the investigation where relevant.
Local standard ≥ 90%
14
Alternative investigation or pathway was considered where appropriate.
Local standard ≥ 90%
15
Outpatient, ambulatory, planned return or community diagnostic option was considered where the patient was otherwise discharge ready and this was safe.
Local standard ≥ 90%
16
Criteria-to-reside or discharge readiness impact was documented where relevant.
Local standard ≥ 90%
17
Expected discharge date was reviewed or updated where the investigation affected discharge.
Local standard ≥ 90%
18
Impact on diagnosis was documented or inferable.
Local standard ≥ 90%
19
Impact on treatment decision was documented or inferable.
Local standard ≥ 90%
20
Impact on discharge or length of stay was documented or inferable.
Local standard ≥ 90%
21
Investigation delay was escalated according to local policy where escalation criteria were met.
Local standard ≥ 90%
22
Diagnostic service, senior clinician or specialist team was contacted where required.
Local standard ≥ 90%
23
Follow-up plan was documented where investigation was outstanding at discharge or converted to outpatient / planned return.
Local standard ≥ 90%
24
Discharge summary included outstanding investigation, result, action or follow-up where relevant.
Local standard ≥ 90%
25
Patient was informed about delayed investigation or follow-up where appropriate.
Local standard ≥ 90%
26
Safety concern was identified and actioned where investigation delay created clinical risk.
Local standard ≥ 90%
27
Documentation was clear enough for another clinician or coordinator to understand the investigation status, delay reason, owner and next action.
Local standard ≥ 90%
28
Any delayed-investigation-related patient safety concern was escalated or actioned where identified.
Local standard ≥ 90%

Clinical safety note

This tool supports local audit, quality improvement and operational governance review. It does not replace clinical judgement, diagnostic pathways, escalation policies, radiology protocols, pathology protocols, specialist advice, discharge policy, criteria-to-reside review, emergency pathways or incident reporting. Any clinical deterioration, missed abnormal result, suspected serious diagnosis, unsafe discharge concern, delayed cancer or time-critical investigation concern, communication failure or patient safety concern must be escalated according to local policy. Do not enter patient names, NHS numbers, hospital numbers, full dates of birth, addresses or other direct identifiers.