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A Practical Handbook for Clinical Audit

Introduction This handbook has been developed with the intention of improving clinical audit at a local level and is designed for use in acute trusts, primary care trusts (PCTs), ambulance trusts and mental health trusts. There are many different models for clinical audit which work well at a local level and the handbook documents the range of models which are applicable and where possible gives examples of good practice. The handbook is designed to give advice and guidance to those organisations where local clinical audit is proving difficult to embed within the trust and to improve its integration into clinical governance. This is an evolutionary document and updates, in particular examples of good practice with contact details, will be added regularly to the web site. My particular thanks to all members of NAGG who have given their time and enthusiasm during the evolution of this document. 6. The clinical audit programme 6.1 Responsibilities 6.2-6.3 Clinical audit priorities and choice of topics 6.4-6.6 Types of clinical audit (prospective vs retrospective) 6.7-6.8 Types of clinical audit (multi-service and multi-professional) 6.9 Patients and clinical audit 6. 1.1 Clinical audit has been variously defined. The standard definition, and certainly the one endorsed by both NICE and the Healthcare Commission is that 'Clinical audit is a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structures, 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'. 1.2 Audit is not a new process. As early as 1750 BC, King Hammurabi of Babylon instigated audit for clinicians with regard to outcome, sometimes with serious consequences for the clinician both financially, and with regard to life and limb, in the event of poor performance. 1.3 Clinical audit has moved on from these early beginnings, but it was only between 1989 and 1990, that monies were first made available to finance the development of audit activity throughout the NHS. Initially medical audit, it soon evolved to encompass all aspects of patient care, and with the involvement of all clinical staff became clinical audit. With the introduction of clinical governance into NHS organisations following the publication of the governments White Paper 'The New NHS …