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”.
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.
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
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.
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.
The National Institute for Clinical Excellence (NICE) 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.
The Care Quality Commission (CQC) is the independent watchdog for healthcare in England. The Commission promote continuous improvement in the services provided by the NHS and regulates health and adult social care services, whether provided by the NHS, local authorities, private companies or voluntary organisations.
The Royal College of Nursing (RCN) 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.
The Royal Society of Medicine Press (RSM Press) is a website that 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.
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 website.
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.
Acknowledgement: This webpage has been written with the help of Stephen Ashmore and Tracy Ruthven of the Clinical Audit Support Centre