PEPs - Clinical Quality and Evidence

Module 3 - Clinical Audit

Introduction and aims

This module looks at clinical audit in the context of quality improvement and service improvement. You will already have looked at the overall module on clinical quality and then the module on evidence. Clinical audit follows on with what we can do with this evidence.

Kenneth Kiser, a pioneer in the USA, who turned round the Veterans Administration Hospitals from a poor performing group of low quality hospitals into the front line of quality and effectiveness, has stated that “you can only improve that which you can measure”. It is believed that he adopted and modified Lord Kelvin’s statement “..when you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind….”

Clinical audit uses measurements, amongst other things, to make improvement by quite rigid assessment that care is given to the patient as dictated by best evidence.

At the end of this module you will:

  • Know about the history of clinical audit
  • Understand the term clinical audit
  • Understand how it relates to research
  • Understand that audit is done to a standard and without such a definition it is impossible
  • Recognise that clinical audit has been in existence for many years
  • Be able to perform a local audit
  • Understand the variety of types of audit, both national and local available.
  • Understand the complimentary roles of national and local audits.
  • Understand the differences between audit, research and service evaluation


Clinical audit can be defined as:

"a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the review of change. Aspects of the structure, process and outcome 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”.

Definition from the National Institute for Health and Clinical Excellence (NICE) paper 'Principles for Best Practice in Clinical Audit'.

Audit and research are different and complementary. Research produces the evidence as to how conditions should be managed and audit seeks to find if such evidence is being used in every day practice.

Clinical audit, therefore, should be seen as part of the processes that clinicians have available to improve services. It is not the only tool but it is an important one.

Attachment: NICE - bestpracticeclinicalaudit.pdf

Principles for Best Practice in Clinical Audit - National Institute for Health and Clinical Excellence (NICE)