Gathering data is only part of the audit process; analysis can provide continued clinical improvements. Dr Siân Williams, a clinical director at the Royal College of Physicians, explains.
When clinical audit is done properly, it can be exciting, revealing and rewarding for the clinicians involved and the quality of the service they are providing. Clinical audit was defined in the publication Principles for best practice in clinical audit in 2002, endorsed by the National Institute for Health and Clinical Excellence (NICE), and this definition is still widely used today (see box).
History of clinical audit
Clinical audit is about an integrated programme of activities with cycles of measuring, reviewing and improving practice - it is not just a data-collecting exercise. Audit was formally introduced 20 years ago in a government White Paper, "Working for patients". Initially it was called medical audit, was quite narrow in its focus and was for doctors to measure their practice.
Definition of Clinical Audit
"Clinical audit is a quality-improvement process that seeks to improve patient care and outcomes through systematic review of care 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."
In the early 1990s the emphasis on audit as a quality-improvement tool increased. Central Government provided ring-fenced money to support local audit committees and involvement of all clinicians, hence the name change from medical to clinical audit. The ring-fenced money ceased in 1995. Over the past 15 years it has been expected that audit will be carried out by all clinicians as part of clinical governance.
Does audit work?
Quality improvement, including audit, is becoming established as a science. Empirical research and theoretical modelling are informing how best to use audit data to effect change in clinical practice.
A systematic review of more than 100 studies has assessed the effect of audit data collection, with feedback to the participants, on the practice