Clinical Audit

At Dorset County Hospital NHS Foundation Trust we value clinical audit as a means to improve the care we provide for our patients. 

We work hard to ensure that we are measuring the quality of the care we provide and that we use this information to improve the service we provide.

Our commitment to clinical audit was recognised in May 2010 when Dorset County Hospital NHS Foundation Trust won a National Audit Award for ‘Creating and Improving Efficiencies’ (full details are included below).

What is clinical audit?

Clinical audit was introduced to the NHS in 1993. However this was by the no means the first time that clinical audit had been used in healthcare.  During the Crimean War (1853-1855) Florence Nightingale measured the effects of her improvements in hygiene and diet.  She was able to demonstrate a drop in mortality rates from 60% to 2.2%. 

The textbook definition of clinical audit is:
'a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change'
Ref: Principles for Best Practice in Clinical Audit (2002, NICE/CHI)

For us the most important parts of this definition are:

  1. That the purpose of clinical audit is to improve patient care
  2. To be a clinical audit, outcomes should be measured against criteria (or standards)
  3. That clinical audit should involve making changes

Clinical audit has five stages:

  • setting standards
  • measuring current practice
  • comparing results with standards
  • changing practice
  • re-auditing

It is best described as an audit cycle:
 audit cycle

How does clinical audit differ from research?

Smith summarised the difference nicely:
'Research is concerned with discovering the right thing to do; audit with ensuring that the right thing is done'.
Smith R.  Audit and Research. BMJ 1992, 305: 905-6
 Clinical audit is therefore about ensuring that we are following agreed best practice. 
This is why national guidelines are so useful as they give us set standards or criteria to measure our performance against.

What audits do we carry out at Dorset County Hospital NHS Foundation Trust?

Each year we plan a clinical audit programme that involves all of our hospital departments.

We prioritise which audits we will carry out and  include audits that:

  • measure how well we protect our patients from infection
  • compare the standard of care we provide against the national averages e.g. for cardiac care or stroke
  •  check we are following national guidelines e.g. NICE guidelines
  • examineareas where we have received complaints or staff have concerns
  • measure our standards of record keeping

What happens with clinical audit results?

We have a system in place at Dorset County Hospital NHS Foundation Trust where the results of all audits (good and bad) are reviewed.  All audits have an action plan which outlines the changes we will make to improve patient care.

We are happy for patients to know the outcomes of our clinical audits and a number of articles are included here which show how we are striving to improve patient care:

Dorset County Hospital NHS Foundation Trust’s award winning audit