Why are clinical audits so important?

Clinical audit definition

Clinical audit is the process formally introduced in 1993 into the United Kingdom's National Health Service (NHS), and is defined as "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".

The key component of clinical audit is that performance is reviewed (or audited) to ensure that what should be done is being done, and if not it provides a framework to enable improvements to be made.

The clinical audit process seeks to identify areas for service improvement, develop and carry out action plans to rectify or improve service provision and then to re-audit to ensure that these changes have an effect.

Clinical audit process

Types of clinical audit

• Patient surveys and focus groups - These are methods used to obtain users' views about the quality of care they have received. Surveys carried out for their own sake are often meaningless, but when they are undertaken to collect data they can be extremely productive.
• Standards-based audit - A cycle which involves defining standards, collecting data to measure current practice against those standards, and implementing any changes deemed necessary.
• Adverse occurrence screening and critical incident monitoring - This is often used to peer review cases which have caused concern or from which there was an unexpected outcome. The multidisciplinary team discusses individual anonymous cases to reflect upon the way the team functioned and to learn for the future. In the primary care setting, this is described as a 'significant event audit'.
• Peer review - An assessment of the quality of care provided by a clinical team with a view to improving clinical care. Individual cases are discussed by peers to determine, with the benefit of hindsight, whether the best care was given. This is similar to the method described above, but might include 'interesting' or 'unusual' cases rather than problematic ones. Unfortunately, recommendations made from these reviews are often not pursued as there is no systematic method to follow.

Clinical Governance is a system through which NHS organisations are accountable for continuously improving the quality of services, and ensures that there are clean lines of accountability within NHS Trusts and that there is a comprehensive programme of quality improvement systems. The six pillars of clinical governance include:

• Clinical Effectiveness
• Research and Development
• Openness
• Risk Management
• Education and Training
• Clinical Audit

Clinical audit was incorporated within Clinical Governance in the 1997 White Paper, "The New NHS, Modern, Dependable", which brought together disparate service improvement processes and formally established them into a coherent Clinical Governance framework.

Clinical audit is an essential and integral part of clinical governance.