Clinical audit - principles and practice for emergency medicine
Clinical audit is a structured, systematic process that measures current clinical practice against explicit, evidence‑based standards, identifies shortfalls, implements changes and re‑measures to ensure sustained improvement. It is a core element of clinical governance and the principal tool for translating guideline recommendations into routine practice (NICE Principles for Best Practice in Clinical Audit).
When to use clinical audit Use clinical audit when you have:
- A clear, evidence‑based standard or guideline that can be expressed as measurable criteria.
- An aim to measure and improve routine clinical practice (service evaluation), not to produce new generalisable knowledge (research).
- A definable patient population or pathway where performance can be assessed and changed through local interventions.
- Examples in the ED include time to antibiotics for sepsis, timely analgesia for sickle cell crises, documentation and management of cardiac arrest, and adherence to mental‑health pathways.
Prerequisites for a valid audit Before data collection begins you must define and document the following items:
- Evidence‑based standards: Explicit standards that are justified by guideline recommendations or high‑quality evidence and expressed in measurable terms, with target performance thresholds where appropriate.
- Audit criteria: Specific, reliable criteria (binary or categorical) that map to each standard and have clearly defined numerator and denominator.
- Population and sampling: Inclusion and exclusion criteria and a sampling strategy that...
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