What are clinical audit and patients' outcomes measurement?

Find out how 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
• patients to question the quality of their care and exercise choice
• the Healthcare Commission to corroborate local bodies' self assessments against national standards
• the Department of Health and NHS Wales to assess progress against national initiatives

Clinical audit and patients' outcomes monitoring are two closely related activities that seek to improve patients' experiences and health through the systematic review of healthcare delivery. They aim to ensure that all patients receive the most effective, up-to-date and appropriate treatment, delivered by clinicians with the right skills and experience. The three broad questions that clinical audit and outcomes monitoring seek to answer can be summarised as:

• are patients given the best care?
• are they better?
• do they feel better?

Clinical audit

This builds on the definition in Principles for Best Practice in Clinical Audit (NICE-CHI, 2002).
During a clinical audit, the care given is recorded and compared with statements (criteria) that define good practice in patient care:

As an example, this could entail the examination of a sample of patients’ notes to record the number of lymph nodes examined in surgical specimens from patients treated with curative intent for intestinal cancer. This is compared against an expectation - that the median number should not fall below 12 in patients with Dukes’ stage B or C colon cancer, because scientific research has established that increasing the number of lymph nodes examined in the surgical specimen will improve the accuracy of staging and will tend to increase long-term survival rates, particularly in patients with colon cancer. There is no consensus on the precise number of nodes that need to be examined, but the research evidence suggests that it should be in double figures. (This example is from NICE, Improving Outcomes in Colorectal Cancers, Manual Update,2004).

Where it is unrealistic to expect criteria to be met every time – e.g., because there are resource constraints, or services need to be re-organised and this will take time – then a standard (sometimes called a target) may be used instead. Hypothetically, related to this example, an initial standard might be that 90% of patients should have 12 or more nodes examined, because it is known that there are insufficient histopathology staff to ensure 100% achievement immediately. In national projects, we place greater weight on standards that are based on NICE guidance, or other evidence-based research published by a national body.

Any aspect of the structure or processes of care can be reviewed, and often many different criteria relevant to the service for a particular group of patients will be measured within one clinical audit project. Where indicated, changes are implemented at an individual, team or service level and care is then re-audited to confirm improvement in healthcare delivery.

Patients' outcomes monitoring

Sometimes agreed good practice criteria do not exist, perhaps because it is difficult ethically to conduct properly controlled scientific trials for a particular aspect of patient care. In some areas of healthcare - often in relation to complex surgery - it is more direct and important to measure outcomes following treatment. In these circumstances, recording the results for individual patients (their outcomes) can supplement or replace 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 outcomes measured can 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.

Clinical audit team

Dick Waite; Clinical Audit Lead
Helen Laing: Commissioning Manager
Victor Oguneymi: Reviewer

Further information

If you would like more information about any aspect of our work on clinical audit, please email:

clinicalaudit@healthcarecommission.org.uk

Back to top