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QuADRANT was a study funded by the European Commission to evaluate clinical audit uptake and implementation across Europe, with an emphasis on clinical audit as mandated within the BSSD (Basic Safety Standards Directive 2013/59/Euratom). The aim of this multiprofesional project was to obtain an overview of European clinical audit activity; identify good practices and resources, barriers and challenges; provide guidance and recommendations going forwards; identify the potential for European Union action on quality and safety in the three core project specialties, radiology, radiotherapy and nuclear medicine.

By a literatura review, European Surveys  to Scientific and Proffessional National Societies, Regulatory Bodies and Health National Authorities and personal interviews to experts in the field,  we assessed the current status of clinical audits and drafted a set of recommendations to facilitate and improve the uptake of clinical audits across Eruope.

QuADRANT identified that developments in national clinical audit infrastructure are required in order to successfully implement clinical audits as a standard of practice in a large scale. National professional societies will be pivotal in improving clinical audit implementation, but resource allocation and national prioritisation of clinical audit are needed in many countries. Lack of staff time and expertise are also barriers. Enablers to enhance clinical audit participation are not widely employed. Development of hospital accreditation programmes can facilitate clinical audit uptake. An active and formalised role for patients in clinical audit practice and policy development is  highly recommended.

We found that there is persisting variation in European awareness of BSSD clinical audit requirements. Work is needed to improve dissemination of information on the legislative requirements relating to clinical audit in the BSSD and in relation to inspection processes to ensure these include clinical audit and that they encompass all clinics and specialties involved in medical applications using ionising radiation.

In conclusion  QuADRANT provides an important step towards enhancing clinical audit uptake and implementation across Europe. Clinical auidts are pivotal in   the  standarisation of practice accross Europe which will result in improving access to standard of care practice,  patient safety and outcomes.