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
- Re-audit of clinical practice

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

Bibliography

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.