What is clinical audit?
Introduction and Background
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. A good example of this is the Community Pharmacists, whose contract in 2005 made clinical audit work a contractual obligation. All NHS Trusts are also 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”.
Although clinical audit is well established and well funded in the NHS, recent national publications have noted the importance of clinical audit but raised questions over how well it is being delivered in the UK. Good Doctors, Safer Patients (2006), the National Audit Office report into the delivery of clinical governance in primary care and the 2007 White Paper Trust, Assurance and Safety have all suggested that improvements are needed in the delivery of clinical audit, with the White Paper concluding that “clinical audit falls short of its potential”.
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 implementation 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 also 68 words long and 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.
Find out more
If you would like to find out more about clinical audit, we would recommend the following:
Principles for Best Practice in Clinical Audit is an excellent publication and regarded by many as the clinical audit bible! The book is published by Radcliffe Medical Press and is also available online via the National Electronic Library for Health website. Click here to access the online version.
The Clinical Audit Handbook was produced by the Clinical Governance Support Team and includes useful information for clinical audit professionals. You can access this document by clicking on the following link.
The Clinical Audit Support Centre have produced a number of podcasts that allow you to access current information relating to clinical audit. You can listen online to news updates and reviews of important events. Click here to go to the podcasc page.