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 healthcare professionals are now expected to participate in clinical audit work and in time it will be a key quality improvement activity for doctor revalidation.
It is fair to say that clinical audit has a ‘mixed’ reputation and national documents endorsed by the Chief Medical Officer – ‘Good Doctors, Safer Patients’ (2006) and the ‘Assurance and Safety’ White Paper (2007) concluded that clinical audit was falling short of its potential and thus needed to be re-invigorated.
Since 2008 the Department of Health have made considerable amounts of funding available for the development of clinical audit. There are now many established National Clinical Audits that Trusts are expected to take part in and the National Advisory Group for Clinical Audit and Enquiries provides guidance to NHS England. Recent years have seen the drivers for clinical audit grow at an exponential rate and now clinical audit activity must be published via Quality Accounts, clinical audit reports are made available to the Care Quality Commission, clinical audit is an integral part of NHSLA arrangements and NICE Quality Standards should be audited. New commissioner/provider relationships have extended the remit of clinical audit and audit work is being linked to relatively new initiatives, such as QIPP, CQUINs, PROMs, etc. Revalidation arrangements (published in 2012) identify that all doctors must take part in quality improvement initiatives and many are likely to opt to conduct clinical audit projects to meet these requirements.
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 should lead to effective changes being implemented that result in improved patient care.