NICOR: National Institute for Cardiovascular Outcomes Research


What is clinical audit?

A quality improvement process for healthcare


Clinical audit is a quality improvement process for healthcare. It aims to enhance the care of patients by systematically reviewing medical practice against explicit criteria, modifying it where necessary. Clinical audit is cyclical, meaning that any standard that is audited against must undergo re-audit to assess the effectiveness of improvements made and encourage further changes, if required.

Clinical audit can be carried out in a number of ways, depending upon the data being collected. An audit’s methodology should always be designed so that it can be easily reproduced for the purposes of re-audit. Clinical audit usually involves looking at information gathered about a patient during a visit to a healthcare environment (e.g. a hospital or GP’s clinic) to see if they received care according to national guidelines and/or whether the proper procedures have been followed by staff.

This information might be in the form of patient’s paper medical notes or electronic documents stored on patient administration systems. The data can be gathered prospectively (as it happens), or retrospectively (after a patient has received treatment). Sometimes clinical audits involve giving patients or healthcare professionals questionnaires to complete. Audit data is usually collected electronically on a spread sheet or in a database, to make analysis of the results easier.

The data is then used to determine whether hospitals are treating patients in accordance with evidence-based standards. Audit analysis allows for comparisons in practice and outcomes both between hospitals and within the same hospital over time.

Clinical audit was introduced to the NHS by the 1989 White Paper ‘Working for Patients’. It is now an established part of the governance framework of the NHS, and all healthcare professionals are expected to participate.

Clinical audit activity is published by hospitals in their annual ‘Quality Accounts’, and clinical audit reports must be made available to Care Quality Commission (CQC) and the NHS Litigation Authority (NHSLA).

Further information about the national clinical audits, and the Health technology registries, that NICOR manages can be found in the relevant sections of these pages.