What is a national clinical audit? Achieving high quality national clinical audit

• Overview 
• How national clinical audit leads to change in practice
• What is patient outcome monitoring?
• Quality in national audit

Overview 

A national clinical audit is either a project funded by HQIP (those in the NCAPOP programme, plus the NJR and PicaNet) or, although separately funded, a project which meets all of the following criteria:

• national coverage (achieved or intended)
• main focus is improving the quality of clinical practice
• evaluates practice against clinical criteria/guidelines and/or collects outcomes data
• applies the complete audit cycle and/or monitors clinical/patient outcomes data in an ongoing way as part of a programme of driving change
• is prospective - i.e. does not include retrospective reviews of adverse outcomes such as confidential enquiries
• includes patients in their governance and takes data from patients themselves.

Confidential enquiries such as the CORP programme funded by HQIP are therefore not in themselves audits, although they have strongly audit like features. Similarly national surveys of patient's experiences and self-reported outcomes are not strictly audits although again they are closely related.

National clinical audit is designed to improve patient outcomes across a wide range of medical, surgical and mental health conditions. Its purpose is to engage all healthcare professionals across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care.

NCAPOP Library: see the latest national clinical audit reports >>

Most national clinical audits have been developed because they are in an area of medicine that is highly important and where it is felt that national results are essential to improve practice and standards. In all cases they form part of a broader approach to improve quality, and fit into the information strategy of the condition involved, especially in areas like cancer or diabetes which have national information strategies.

Such audits are backed by the relevant Royal College and the national clinical director concerned, and usually have the support and engagement of the relevant national voluntary organisation which represents patient interests.

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How national clinical audit leads to change in practice

Clinical audit improves patient outcomes by improving professional practice and the general quality of services delivered.

The projects allow:

• local bodies to identify and make local improvements for patients
• individual clinicians and teams to benchmark practice and performance
• patients to question the quality of their care and exercise choice
• the Care Quality Commission to corroborate local bodies' self assessments against national standards
• the Department of Health and NHS Wales to assess progress against national initiatives.

Clinicians, and their employing Trusts, should view a well designed and effective national audit programme as an essential tool for them to improve services and assess performance.

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What is patient outcome monitoring?

Patient outcomes monitoring is closely related to clinical audit, and can form part of clinical audit alongside other studies which measure the patient experience as a whole.

In some areas of healthcare - often in relation to complex surgery - it is important and relatively easy to measure clinical outcomes following treatment. In these circumstances, recording the results for individual patients (their outcomes and their views of the care received) can supplement an audit of what has been done to them.

Such projects can become multicentre clinical databases that use sophisticated IT to collect and analyse physiological, medical and other personal information from patients on a continuous basis across the whole country. This information is usually adjusted according to the 'case mix' so that reliable evidence about the quality of care and patients' outcomes is available for clinicians, managers, patients and the public. It also measures whether patients survive and get better physically.

The criteria measured should include patients' views about whether they were treated with dignity and humanity, how quickly they were seen and treated, and their quality of life afterwards.

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Quality in national audit

A national audit report should offer these benefits:

• Reassure: every healthcare organisation should take proper steps to audit the quality of its care, and be able to show to patients and the wider public that it provides safe and effective services and that any deficiencies are being rectified. A national audit report is a very important step in providing that public assurance.
• Encourage: timely and useful feedback, together with suggested action plans and examples of good practice, act as a spur to those that need to improve to begin to act.
• Advise: providing professional feedback is a stimulus for improvement for all healthcare professionals to interpret the findings and identify how (if at all) they are able to further improve their services to patients. A national report, in plain language, enables chief executives, boards and patients to question whether their clinicians are using the audit findings in the way intended.

National audits have multiple purposes and have different values for various stakeholders. Patients, clinicians, managers, policy makers, regulators and commissioners will all have their own particular ideas about what quality in national audit is.  HQIP believes that there are a set of criteria which clearly mark out quality in clinical audit as a whole and national audit specifically. A set of general principles about quality in clinical audit in all settings is found here.

A specific set of criteria for various stakeholders defining aspects  of quality in national audit, published in October 2011, is found here:

HQIP guide to Assessing and Improving quality in National Clinical Audits >>

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