Clinical audit | Health Knowledge

Adapted from Principles for best practice in clinical audit. NICE 2002

Clinical audit is the review of a process or practice or outcomes against a pre-agreed set of standards and forms part of the quality improvement process. It is central to improving quality standards within healthcare and is an important part of maintaining high standards and patient safety. Clinical audit should form an intrinsic part of clinical activity - it should not be a one-off random process and should be conducted regularly to monitor for improvements (or failures) in clinical practice. Clinical audit is a key pillar of clinical governance and should be carried out by all healthcare staff.

The five stages of audit

Stage 1: Preparing for audit:

Define the purpose of the audit
Involve service users in the audit process
Provide the necessary structures for the audit
Identify the resources required for undertaking the audit (people, skills, training, funding, equipment)
Include service user involvement where appropriate

Stage 2: Selecting audit criteria

Criteria must explicitly define what is being measured and must represent elements of care which can be measured objectively. Criteria must be valid and appropriate.

Criteria can be selected from:

Guidelines (e.g. NICE guidelines)
Standards based on professional or consensus opinion
Service user-defined measures (e.g. outcome measures)
Set performance levels
Care pathways

Stage 3: Measuring level of performance

Planning data collection:

Inclusion criteria – i.e. who should be included in the audit (with any exceptions to be noted)
Which healthcare professionals should be included in the audit i.e. who provides the patient’s care for the audit
Sample size
The time period over which the criteria apply
Data sources to use - consider retrospective versus prospective collection
Plan data analysis
Consider and plan for any data protection issues

Stage 4: Making improvements

Disseminating results
Changing behaviours

Stage 5: Sustaining improvement

Regular audit
Clinical performance indicators

Clinical audit should be an intrinsic part of quality management within a health care organisation and participation in audit should be encouraged amongst all staff groups. The diagram above shows the five stages as a cycle, and this represents the ongoing nature of audit and continual re-audit to assess that standards continue to be met.

There are also national audit programmes. These often collect and analyse data supplied by local clinicians to provide a national picture. Data is also analysed to benchmark acute Trusts. Examples are:

Sentinel Stroke National Audit Programme (SSNAP)
National Emergency Laparotomy Audit (NELA)