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Clinical Audit

History/Background

The (1989) White Paper Working for Patients and the NHS Act 1990 introduced mandatory medical audit. Clinical Audit evolved from medical audit during 1993. Clinical audit was placed in the realms of quality and considered to be a multi-disciplinary approach to auditing.

The (1997) White Paper The New NHS: Modern, Dependable reinforced the position of clinical audit as an essential element of professional practice in the Health Service.

Furthermore, the (1998) White Paper A First Class Service confirmed that all hospital doctors should participate in the audit programmes. This was supported further by the (2000) White Paper The NHS Plan: A Plan for Investment. A Plan for Reform which introduced significant changes, identifying clinical audit to be a mandatory activity for all healthcare professionals.

The GMC also advises doctors that they “must take part in regular and systematic medical and clinical audit, recording data honestly” (General Medical Council 2001).

The UK Central Council for Nursing, Midwifery and Health Visiting also agrees that clinical governance and assisting with the co-ordination of quality improvement initiatives such as clinical audit is: ‘the business of every registered practitioner’ (UK Central Council for Nursing, Midwifery and Health Visiting, 2001).

The Bristol Royal Infirmary Inquiry recommendations 143-145 reinforce that clinical audit must be “a system of local monitoring of performance,” “fully supported by trusts,” “compulsory for all healthcare professionals providing clinical care” and “included as part of the contract of employment” (Learning from Bristol: the Department of Health’s Response to the Report of the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984 – 1995).

More recently the (2007) White Paper Trust, Assurance and Safety outlines the importance of audits at both a national and local level and highlights its role in supporting continuous improvements in patient care and service delivery.

Clinical audit was not specifically mentioned in Lord Darzi's recent (2008) report 'High Quality Care For All, however Lord Darzi highlights that quality should be at the “heart of everything we do”. In the latest ‘Liberating the NHS' White Paper Secretary of State for Health Andrew Lansley has singled out clinical audit as key driver for the Government's vision for the NHS.

What is Clinical Audit?

The current accepted definition of clinical audit, endorsed by the National Institute of Clinical Excellence (NICE) 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 outcomes 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. (NICE 2002).

The Clinical Audit process in known as the ‘audit cycle’, this has been diagrammatically displayed:
The Audit Cycle

The main components of the audit cycle are:

Choose a topic;
Review current standards or agree standards;
Collect data on current practice;
Use data to make comparisons with standards;
Implement change(s) to make improvements/benefits;
Re-audit to make sure practice has improved.

What are the benefits of Clinical Audit?

Clinical Audit is a quality improvement process and therefore benefits of undertaking audit include:

Improvements in practice: creating real benefits in patient care and service delivery;
Develops openness to change;
Provide assurance: meeting evidence-based best practice;
Listening to patients, understanding their expectations;
Development of local guidelines or protocols;
Minimise error or harm to patients;
Reduce incidents/complaints/claims.

Can I get help with my Clinical Audit?

Yes, the Clinical Effectiveness and Evaluation Department can help with the following areas:

Provide support and advice on audits;
Find standards/guidelines;
Develop proformas or patient questionnaires;
Provide a note pulling service;
Analyse data;
Produce presentation and/or reports;
Work in conjunction with audit participants to produce action plans. Action Plans address audit recommendations, ensuring there is ownership and an agreed timescale for necessary changes to be implemented.

Am I conducting Research or Clinical Audit?

Sometimes it can be very difficult to determine whether your project is Research or Clinical Audit. A brief synopsis of the differences have been explained below:

Research asks the question ‘what is best practice?’ researches will seek to find new knowledge.

Clinical Audit asks the question ‘are we following agreed or evidence based practice?’ auditors will seeks to find out if we are achieving the things we have agreed we should be achieving.

I think my project is Research

Please see the section on Research & Development for more information on Research.

If you are in still in doubt, please contact the Research & Development Manager, Dr Essam Ramhamadany who will be able to discuss your project and also provide to you support and guidance.

Do I need to register my audit?

Yes, it is now a mandatory requirement for all audits to be registered with the Clinical Effectiveness and Evaluation Department. Registration of audits supports the Trusts Clinical Audit Annual Report.

You will need to submit the following document to the department to register your audit:
Clinical Audit Registration and Approval Form

What other documents do I need to submit?

The Clinical Effectiveness and Evaluation Department will need to be provided with a copy of the following documents: