A lesson on clinical audits at the CQI Greater Peterborough and Cambridge branch

The role of clinical audit has come into the spotlight amid criticism against current practices at the NHS. The CQI Greater Peterborough and Cambridge branch organised a gathering to present a different perspective on audit in the health sector.

Josefina Gil-Moya gave a detailed presentation on Clinical Audit within the NHS. Gil-Moya is the clinical audit and effectiveness lead at Cambridge University Hospitals NHS Foundation Trust, based at Addenbrooke’s Hospital. She has worked as a quality professional supporting compliance with regulatory and accreditation bodies in health care for the last 10 years. 

“The time has come for everyone in the NHS to take clinical audit very seriously,” Gil-Moya said.

Gil-Moya and her team at Addenbrooke’s provide ongoing support in the shape of monitoring, registration and submission of audit data to clinicians, HQIP (NHS England), and the different Royal Colleges to ensure shortfalls and good practices are highlighted and shared with other health-care providers and the general public.

Clinical audits has roots in the Crimean War, when Florence Nightingale worked to improve unsanitary hospital conditions. The practice of clinical audit was formally introduced in the 1989 government white paper Working for Patients and was implemented in the NHS the following year. Today, the National Institute for Clinical Excellence, and the Healthcare and Quality Improvement Partnership (HQIP) play critical roles in advancing contemporary clinical audit.

Clinical audit provides the framework to improve the quality of patient care in a collaborative and systematic way. It is about measuring the quality of care provided against the relevant standards.

HQIP’s Guide to Using Quality Improvement Tools to Drive Clinical Audits is a modified version of the traditional clinical audit cycle. The modern clinical audit cycle includes the following stages:

Stage 1: Preparation and planning (including re-audit)

Stage 2: Measuring performance

Stage 3: Implementing change

Stage 4: Sustaining improvement (including re-audit)

The following processes apply between stages two and three:

• Checking clinical audit findings
• Reporting on compliance
• Analysing variations in clinical practice
• Analysing shortcomings in care to find their root causes
• Planning and taking the corrective actions

When clinical audit is conducted well, it enables the quality of care to be reviewed objectively within an approach that is supportive, developmental and focused on improvement. If there are failures to meet the standards, audits should help with understanding the factors that are causing these failures, enabling clinicians to set priorities and make improvements.