All about audit

A practical guide to the audit process

how to do audit

Summary document

Clinical governance support and development unit (Wales)



A summary guide for the NHS in Wales


Clinical Audit is the systematic and critical analysis of the quality of clinical care.  It answers the question – “Are you doing as well as you should?” It encourages you to “do it better”. Ideally it is a continuous process of self-monitoring and change towards improvement in the quality of health care delivery.  It can review the procedures used for diagnosis or assessment of patients, treatment and care, the associated use of resources and the resulting outcome and quality of life for patients (and health workers)



What are you trying to do?     (Health care planning and delivery)

How well are you doing?        (Review and audit)

How do you do it better?        (Consensus, CPD and making changes)


















You may be familiar with the Audit Cycle or perhaps the Audit Spiral where standards are being continually raised and aspired to. This describes a continuous process of learning and development – not a project to be completed and put on an office shelf. A good Clinical Audit will be a working document for the clinical team to use on a day to day basis


1       Choose your topic


· Local problems and priorities

· National strategies or guidelines

· User views or complaints


1.1        What makes a good topic?


· Important

· Measurable

· Amenable to change

· Achievable within your resources (IT, space, financial and human)


1.2        What is an important topic?


· High level of concern

· Potential high impact on health of patients or health service resources

· Common procedures or conditions


2           Define your Aims and Objectives


2.1     Aims                 Why are you doing this project? What are you hoping to achieve?

2.2     Objectives       What specifically are you hoping to improve and assess?


3        Set your Standards


3.1     State the Criteria – elements of care or activity which can be measured  

Set your desired level of performance or target (usually a percentage)


    Where do you get your standards from?


· National

· Regional

· Local

· Other teams (local audit office)


4           Collect your data / agree your method


             4.1        Consider;


· Retrospective or prospective

· Who is your target population?

· What data will you collect – only what is absolutely necessary

· Who will collect the data?

· Where will you get the data from?

· What time period will you use (i.e. start date and finish date)?

· How will you select your sample (how many subjects do you need)?


4.2     Sources of data;


· Clinical records

· Disease or activity data sets

· Survey/questionnaire

· Interview


If you are undertaking a large audit or using unfamiliar data collection tools, PILOT first


5           Analyse you data


· Do you need statistical help?

· Use spreadsheets if you can.

· Present your data in a visually appealing, succinct, easily understood way


6           Interpret your data


· What does it mean?

· How does it compare with your target?


7           What changes need to be made?


· How are you going to implement them?

· Who needs to be involved?

· What new resources do you need?


8           Make the changes / set new targets


9           Plan when you will do the next audit cycle


Characteristics of a good audit


· It has a clear purpose and is focussed

· It has educational value

· It is multidisciplinary (as appropriate)

· It is inclusive of all stakeholders including patients

· There is interest, understanding and support from management

· There is a strong desire to improve and a willingness to change

· Only relevant information is collected

· It is efficient with resources

· It leads to change.


For more information please refer to Introduction to Clinical Audit Workbook

(Welsh Assembly Government 2002)