Clinical Audit Improves Patient Care and Outcomes

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Clinical audit is a process that has been 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. It had been formally incorporated in the healthcare systems of a number of countries.

As concepts of clinical audit have developed, so too have the definitions which sought to encapsulate and explain the idea. These changes generally reflect the movement away from the medico-centric views of the mid-Twentieth Century to the more multidisciplinary approach used in modern healthcare. It also reflects the change in focus from a professionally-centred view of health provision to the view of the patient-centred approach. These changes can be seen from comparison of the following definitions.

In 1989, the White Paper, Working for patients, saw the first move in the UK to standardise clinical audit as part of professional healthcare. The paper defined medical audit (as it was called then) as "the systematic critical analysis of the quality of medical care including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient."

Medical audit later evolved into clinical audit and a revised definition was announced by the NHS Executive:

"Clinical audit is the systematic analysis of the quality of healthcare, including the procedures used for diagnosis, treatment and care, the use of resources and the resulting outcome and quality of life for the patient."

The National Institute for Health and Clinical Excellence (NICE) published the paper Principles for Best Practice in Clinical Audit, which defines clinical audit 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. Aspects of the structure, processes, 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.

Clinical Audit - The Process

Stage 1: Identify the problem or issue

This stage involves the selection of a topic or issue to be audited, and is likely to involve measuring adherence to healthcare processes that have been shown to produce best outcomes for patients. Selection of an audit topic is influenced by factors including:

• where national standards and guidelines exist; where there is conclusive evidence about effective clinical practice (i.e. evidence based medicine).

• areas where problems have been encountered in practice.

• what patients & public have recommended that be looked at.

• where there is a clear potential for improving service delivery.

• areas of high volume, high risk or high cost, in which improvements can be made.

In our next blog article we will outline the next 4 processes of clinical audits that improve patient care.  Subscribers to our blog will receive the updates.