Clinical audit

Adapted from Principles for best practice in clinical audit. NICE 2002 


Clinical audit is the review of a process or practice or outcomes against a pre-agreed set of standards and forms part of the quality improvement process. It is central to improving quality standards within healthcare and is an important part of maintaining high standards and patient safety. Clinical audit should form an intrinsic part of clinical activity - it should not be a one-off random process and should be conducted regularly to monitor for improvements (or failures) in clinical practice. Clinical audit is a key pillar of clinical governance and should be carried out by all healthcare staff.



The five stages of audit

Stage 1: Preparing for audit:

  • Define the purpose of the audit
  • Involve service users in the audit process
  • Provide the necessary structures for the audit
  • Identify the resources required for undertaking the audit (people, skills, training, funding, equipment)
  • Include service user involvement where appropriate

Stage 2: Selecting audit criteria

Criteria must explicitly define what is being measured and must represent elements of care which can be measured objectively. Criteria must be valid and appropriate.

Criteria can be selected from:

  • Guidelines (e.g. NICE guidelines)
  • Standards based on professional or consensus opinion
  • Service user-defined measures (e.g. outcome measures)
  • Set performance levels
  • Care pathways

Stage 3: Measuring level of performance

Planning data collection:

  • Inclusion criteria – i.e. who should be included in the audit (with any exceptions to be noted)
  • Which healthcare professionals should be included in the audit i.e. who provides the patient’s care for the audit
  • Sample size
  • The time period over which the criteria apply
  • Data sources to use - consider retrospective versus prospective collection
  • Plan data analysis
  • Consider and plan for any data protection issues

Stage 4: Making improvements

  • Disseminating results
  • Changing behaviours

Stage 5: Sustaining improvement

  • Regular audit
  • Clinical performance indicators


Clinical audit should be an intrinsic part of quality management within a health care organisation and participation in audit should be encouraged amongst all staff groups. The diagram above shows the five stages as a cycle, and this represents the ongoing nature of audit and continual re-audit to assess that standards continue to be met.

There are also national audit programmes. These often collect and analyse data supplied by local clinicians to provide a national picture. Data is also analysed to benchmark acute Trusts. Examples are:

  • Sentinel Stroke National Audit Programme (SSNAP)
  • National Emergency Laparotomy Audit (NELA)



                                                 © Rosalind Blackwood 2009, Claire Currie 2016