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About Clinical Audit

"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. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery."
National Institute for Health and Clinical Excellence

The key difference between clinical audit and research is that research seeks to derive generalisable new knowledge, whereas audit and related activities assess how existing knowledge is applied in specific settings. The BHIVA clinical audit sub-committee uses the following table from the Central Office of Research Ethics Committees when planning its programme, which includes service evaluation in relation to aspects of care for which no standard has yet been established:

 

RESEARCH CLINICAL AUDIT SERVICE EVALUATION
Designed and conducted to generate new knowledge Designed and conducted to provide new knowledge to provide best care Designed and conducted to define current care
Quantitative research - hypothesis based

Qualitative research - explores themes following established methodology
Designed to answer the question:

"Does this service reach a predetermined standard?"
Designed to answer the question:

"What standard does this service achieve?"
  Measures against a standard Measures current service without reference to a standard
May involve a new treatment Doesn’t involve a new treatment Doesn’t involve a new treatment
May involve additional therapies, samples or investigations Involves no more than administration of questionnaire or record analysis Involves no more than administration of simple interview, questionnaire or record analysis
May involve allocation to treatment groups NOT chosen by HCP or patient Does not involve allocation to treatment groups: the HCP and patients choose treatment Does not involve allocation to treatment groups: the HCP and patients choose treatment
May involve randomisation Does NOT involve randomisation Does NOT involve randomisation
ALTHOUGH ANY OFTHESE THREE MAY RAISE ETHICAL ISSUES, UNDER CURRENT GUIDANCE:-
RESEARCH REQUIRES R.E.C. REVIEW AUDIT DOES NOT REQUIRE R.E.C. REVIEW SERVICE EVALUATION DOES NOT REQUIRE R.E.C. REVIEW