Clinical Audit
What is Clinical Audit?
Clinical audit is a quality improvement process that was introduced
to the NHS by the 1989 White Paper Working for Patients. Previously
known as medical audit until a name change in the early 1990’s,
clinical audit involves reviewing the delivery of healthcare to ensure
that best practice is being carried out.
Clinical audit is now an established part of the NHS landscape and
a key component of the clinical governance framework. In recent times
there has been a move away from “optional” clinical audit
activity to a more “obligatory” approach. All
NHS Trusts are currently monitored by the Healthcare Commission to
make sure that clinical audit work is being carried out. Standard
C5d of Standards for Better Health explicitly states “healthcare
organisations should ensure that clinicians participate in regular
clinical audit and reviews of service”. If Standards
for Better Health are extended in full across general practice, then
clinical audit will become another “must do”.
Definitions
Since audit was introduced in 1989 there have been many different
definitions of clinical audit. The current accepted definition appears
in Principles for Best Practice in Clinical Audit (2002) and was
endorsed by the National Institute of Clinical Excellence:
“Clinical audit is a quality improvement process that seeks to improve
patient care and outcomes through systematic review of care against explicit
criteria and the review of change. Aspects of the structure, process and outcome
of care are selected and systematically evaluated against explicit criteria.
Where indicated changes are implemented at an individual, team, or service
level and further monitoring is used to confirm improvement in healthcare delivery”.
Although this is an excellent technical definition of clinical audit
it is unlikely to inspire healthcare professionals to take part in
clinical audit work. Ironically, the 1989 White Paper Working for
Patients provided a far shorter and simpler definition of audit:
“Audit involves improving the quality of patient care by looking at current
practice and modifying it where necessary”.
Clinical audit is essentially all about checking whether best practice
is being followed and making improvements if there are shortfalls
in the delivery of care. A good clinical audit will identify (or
confirm) problems and lead to effective changes that result in improved
patient care.
Useful Clinical Audit Resources
The following books and websites are recommended:
‘Principles for Best Practice in Clinical Audit’ – published
by NICE/RCN and University of Leicester in 2002 and available in
PDF via the NHS library website www.library.nhs.uk
‘A Practical Handbook for Clinical Audit’ – available
to download from the Clinical Governance Support Team website - www.cgsupport.nhs.uk
www.clinicalauditsupport.com – the
Clinical Audit Support Centre offer a range of accredited training
courses in clinical audit and supply a variety of materials, including
electronic validation tools that assist practices in developing accurate
practice disease registers – an essential starting point for
undertaking a high quality clinical audit project.
www.cgsupport.nhs.uk – the
Clinical Governance Support Team website is a fantastic resource
and houses a wide range of clinical governance-related materials.
Although the CGST closed its doors in March 2008, the website is
still accessible and contains a range of useful materials relating
to clinical audit.
www.library.nhs.uk – the
National Library for Health is intended to act as a source of authoritative
evidence and best practice to support health care in the NHS. The
resource can be used to search expert libraries, books and journals,
etc for best practice and other resources relating to clinical audit.
www.nice.org.uk – The
National Institute for Clinical Excellence develop a series of national
clinical guidelines to secure consistent, high quality, evidence-
based care. NICE also develop audit criteria that enables healthcare
professionals to assess how well guidance is being implemented.
www.healthcarecommission.org.uk – The
Healthcare Commission is the independent watchdog for healthcare
in England. The Commission promote continuous improvement in the
services provided by the NHS and are also responsible for reviewing
complaints. The Commission have been involved in the delivery of
the national clinical audit programme.
www.cg4cp.org.uk – although
this website is aimed primarily at community pharmacists it houses
a range of clinical governance resources, including a basic training
session on clinical audit. Those who want to utilise the site must
register their details, but there are no restrictions on who can
sign in.
www.rcn.org.uk - The Royal
College of Nursing represents nurses and nursing, promotes excellence
in practice and shapes health policies. By accessing the website
RCN members can go directly to a list of recent articles on audit
and clinical governance via the RCN library pages.
www.rsmpress.co.uk – this
website includes back issues of the Clinical Governance Bulletin.
Although the bulletin is no longer published practice staff may find
the site useful for looking at previously conducted clinical governance
and audit initiatives.
Clinical Audit Podcasts
The Clinical Audit Support Centre has produced a number of podcasts
that allow you to access current information relating to clinical
audit. You can listen to podcasts on your PC giving audit news
updates and reviews of important events. You can access the
full list of the Clinical Audit Support Centre’s podcasts here.
Podcast on the Clinical
Audit process – this podcast
will be of interest to anyone new to clinical audit as it explains
how to undertake a clinical audit project – click here
Acknowledgement: This webpage has
been written with the help of Stephen Ashmore and Tracy Ruthven
of the Clinical Audit Support Centre.
