Audit

Background

Clinical audit has been defined as a quality improvement strategy that intends to measure and improve the care and outcomes patients experience. [1] It is a proven and effective process for measuring quality and driving improvement. [2]
An audit is conducted to evaluate how close local practice is to best practice and identify gaps. It is snapshot of current practice against best practice, target performance. This is done by the selection of aspects of patient care and the evaluation of the performance of a service against an agreed set of criteria or standards to answer the following questions:

  • What is happening now? (baseline) 
  • What should be happening? (according to evidence, best practice, other agreed standards, which provide the criteria for the audit) 
  • How can we improve? (changes and interventions required)
  • Have our improvements resulted in a change? (repeated audits as part of the cycle to close the gap). 

Clinical audit is a fundamental component of maintaining high standards of clinical excellence. Therefore, it is essential that healthcare professionals at every level understand what clinical audits are, how they should work, how the results of clinical audits contribute to excellent care and how working knowledge of clinical audit can advance their careers. [3] Audits provide information about processes and, importantly, outcomes for patients and families. These outcomes need to be monitored on a continuous basis through an audit schedule and the results reported at relevant committees such as a Patient Safety and Quality committee.

Key messages 

  • A Cochrane systematic review of audit and feedback, which is defined as ‘a summary of clinical performance over a specified period of time, shows that audit generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided [4] It may be more effective when the baseline performance is low, when the feedback is provided by a senior colleague, both verbally and written, more than one, and when it includes both measurable targets and an action plan
  • The audit and feedback development needs to consider the audit component in relation to how and what data is collected and ensure audit cycles are repeated, the feedback component to include multi-modal methods of providing the feedback, the nature of the behaviour change required and explicit goals and action plans are included as part of the feedback. [5]

PubMed Searches

  1. National Institute for Clinical Excellence. Principles for best practice in clinical audit. Abingdon: Radcliffe Medical Press; 2002.
  2. Burgess R, editor. New principles of best practice in clinical audit. 2nd ed. Oxford(GB): Radcliffe publishing; 2011.
  3. Dhamija B, Keane M, Low C. Clinical audit for doctors and healthcare professionals: a comprehensive guide to best practice as part of clinical governance. London: BPP Learning Media; 2011.
  4. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;6:CD000259.
  5. Ivers NM, Sales A, Colquhoun H, Michie S, Foy R, Francis JJ, et al. No more ‘business as usual’ with audit and feedback interventions: towards an agenda for a reinvigorated intervention. Implement Sci. 2014 Jan 17(9):14. 
Last updated 18 January 2017