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Clinical governance and audit

Clinical governance

'..a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards by creating an environment in which excellence in clinical care will flourish.'

  • Purpose of clinical governance is to ensure that patients receive the highest quality of care
  • Covers organisational systems and processes for monitoring and improving services including:
    • Consultation and patient involvement
    • Clinical risk management
    • Clinical audit
    • Research and effectiveness
    • Staffing and staff management
    • Education, training and continuing professional development
    • The use of information about experience, outcome and processes
  • Effective clinical governance should ensure:
    • Continuous improvement of patient services and care
    • A patient-centred approach to care
    • A commitment to quality
    • The prevention of clinical errors

Clinical audit

'The systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, to help to provide reassurance that the best quality of service is being achieved, having regard to the available resources'

  • Medical audit = Assessment by peer review of medical care
  • Clinical audit = Assessment of total care

Medical audit

  • Involves a systematic approach
  • Highlights opportunities for improvement
  • Provides mechanism for change
  • Is different from case presentation, morbidity & mortality meetings

Clinical audit

  • Can assess:
    • Structure - type of resources
    • Process - what is done to patients
    • Outcome - the result of clinical interventions

Audit cycle

  • The audit cycle involves:
    • Observation of existing practice
    • The setting of standards
    • Comparison between observed and set standards
    • Implementation of change
    • Reaudit of clinical practice

The audit loop

Audit techniques

  • Basic clinical audit - throughput, morbidity, mortality
  • Incident review - critical incident reporting
  • Clinical record review
  • Criterion audit - retrospective analysis judged against chosen criteria
  • Adverse occurrence screening
  • Focused audit studies - specific outcome
  • Global audit - comparison between units
  • National studies - e.g. NCEPOD

Essential features of comparative audit

  • High quality data collection
  • Relevant and valid measure of outcome
  • Appropriate and valid measures of case mix
  • A representative population
  • Appropriate statistical analysis


Babu E D,  Khan A Z,  Khashaba A et al.  Clinical audit:  can we improve further?  J R Coll Surg Ed 2001;  46:  171-172

Gilmore I.  Clinical governance:  what it is, what is isn't and what is should be.  Hosp Med 2000:  61:  51-53.

Irvine C D,  Grayson D,  Lusby R J.  Clinical governance and the vascular surgeon.  Br J Surg 2000;  87:  766-770.

Mason A.  the emerging role of clinical audit.  Clin Med 2002;  2:  294-296.

Scott P V.  Differentiating between audit and research.  Clinical audit is research.  Br Med J 2000;  320:  713

Thomas H.  Clinical governance and revalidation.  Hosp Med 1999;  60:  892-896.



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