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A quality improvement process that seeks to
improve patient care and outcomes thorough
systematic review of care, against explicit criteria
and the implementation of change.
That is to say the performance is being reviewed
(audited) to make sure that what should be done
is being done.
And if not, it provides a framework for
improvements to be made.
Clinical audit has been incorporated as an
essential part of the clinical governance in many
Since 1993 in UK for example.
Clinical auditing as part of the clinical governance has
many advantages and benefits to the organization:
To identify whether standards are being met, and evidence
from research are being used in practice.
To identify baselines for development of standards.
To reduce clinical risk.
To ensure cost effective use of resources, and effectiveness
of a service.
To highlight problems, and help in the solution.
To improve team working and communication.
To improve patient care and outcomes.
One of first ever clinical audits was undertaken
by Florence Nightingale during the Crimean War of
She and her team of 38 nurses applied strict sanitary
routines and standards of hygiene to the hospital and
Kept meticulous records of the mortality rates
among the hospital patients.
Following these changes the mortality rates fell
from 40% to 2%.
Are we singing the right song?
Are we singing this song right?
In this stage the audit team will identify a
problem, or an area of healthcare service
that is to be compared to standards.
Standards and guidelines exist, and there is
conclusive evidence about effective clinical
Problems have been encountered in practice.
There have been recommendations or complains
from the patients or public.
There is high volume, high risk, or high cost.
There is clear potential of improvement of service.
1. The structure: resources and personnel available to
enable healthcare professionals to perform their jobs
(eg. Skills – provision of equipment).
2. The process: focuses on the amount, type, and
appropriateness of clinical care (eg. Quality of CPR
– antibiotics prescription).
3. The outcome: focuses on the result of an
intervention (eg. Patient satisfaction – pain relief).
Decisions regarding the overall purpose of the audit, either as what
should happen as a result of the audit, or what question you want the
audit to answer, should be written as a series of statements or tasks that
the audit will focus on. Collectively, these form the audit criteria.
A criterion is a measurable outcome of care. For
example, ‘Patients in the ICU should receive GIT
A standard is the threshold of the expected
compliance for each criterion (these are usually
expressed as a percentage). For the above example
an appropriate standard would be: ‘GIT bleeding
prophylaxis received in 90% of cases’.
The audit team should start by collecting
available standards and guidelines
concerning the topic of the audit, from
the best available and most updated
sources, and agree on them among
Then they should formulate the
standards as a series of statements or
tasks that the audit will concentrate on.
Those statements will be the criteria of
Clear, not vague
To the topic
As well as Theoretically sound
•Data collection sheets or
questioners developed by the
•The type of collected data
taken in consideration.
•Simple Statistical analysis
based on the type of data
•Clinical Audit Facilitator.
Analysis stage, whereby the results of the data
collection are compared with criteria and standards.
The end stage of analysis is concluding how well
the standards were met and, if applicable,
identifying reasons why the standards weren't met in
These reasons might be agreed to be acceptable, i.e.
could be added to the exception criteria for the
standard in future, or will suggest a focus for
In theory, any case where the standard was not met
in 100% of cases suggests a potential for
improvement in care.
In practice, where standard results were close to
100%, it might be agreed that any further
improvement will be difficult to obtain.
And that other standards, with results further away
from 100%, are the priority targets for action.
This decision will depend on the topic area, in some
‘life or death’ type cases, it will be important to
achieve 100%, in other areas a much lower result
might still be considered acceptable.
Conclude if standards were met, and if not,
because of what.
What needs to be done about that?
Is the solution practical?
Was the standard itself applicable ? (perhaps
exclusion criteria should be added).
Share your results…
Once the results of the audit have been published
and discussed, it is time to formulate and action
plan, that should include;
o What needs to be done or changed.
o Who is going to do it.
o When it is going to be done.
o How it will be done.
o Involve higher authorities.
After an agreed time frame, the audit should be
The same methods and data analysis are used to
The re-audit should demonstrate that the changes
have been implemented and that improvements have
This stage is critical to the successful outcome of
the audit process as it verifies whether the changes
implemented have had an effect.