The Competent Novice

Audit: how to do it in practice

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39527.628322.AD (Published 29 May 2008)
Cite this as: BMJ 2008;336:1241

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  1. Andrea Benjamin, clinical editor, foundation programme
  1. 1BMJ Learning, BMA House, London WC1H 9JR
  1. ABenjamin{at}bmjgroup.com

    Junior doctors can find the process of doing an audit helpful in gaining an understanding of the healthcare process—here’s how to do one

    Key points

    • Audit measures practice against performance

    • The audit cycle involves five stages: preparing for audit; selecting criteria; measuring performance level; making improvements; sustaining improvements

    • Choose audit topics based on high risk, high volume, or high cost problems, or on national clinical audits, national service frameworks, or guidelines from the National Institute for Health and Clinical Excellence

    • Derive standards from good quality guidelines

    • Use action plans to overcome the local barriers to change and identify those responsible for service improvement

    • Repeat the audit to find out whether improvements in care have been implemented after the first audit

    In the United Kingdom, doctors in the first two years after graduation are asked to perform an audit. Audit measures practice against standards. Unlike research (which asks the question, “what is the right thing to do?”), clinical audit asks, “are we doing the right thing in the right way?”1

    Clinical audit forms part of clinical governance, which aims to ensure that patients receive the best quality of care. Clinical governance is often defined as how NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care.2

    Audit can include assessment of:

    • The structure of care—for example, resources such as the presence of a dedicated stroke unit

    • The process of care—for example, waiting times in clinics

    • The outcome of care—for example, blood pressure reduction in response to therapy.

    Audit should also be transparent. It should not be confrontational or judgmental—it is not an opportunity to name, shame, and blame.

    Does audit work?

    There is conflicting evidence on whether audit works. Audit and feedback has not consistently been found to be effective.3 For every success story there …

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