To better understand a clinical audit, let’s first look at an example.
A Restaurant Example
Imagine a restaurant owner who runs his business successfully. He has set specific rules and standards for everything, such as:
- How should a customer be greeted?
- How should orders be taken?
- How should food be served?
- How should chefs handle ingredients in the kitchen?
Why Are These Rules Set?
These rules ensure the smooth operation of the business.
If something goes wrong and affects the business or the customer’s experience, these rules help in identifying issues and making improvements.
For instance, if food that should be served within 15 minutes takes 45 or more minutes, this is a problem.
How Does the Restaurant Owner Fix This?
He assesses the process to determine why there is a delay. He may ask:
- Is the staff understaffed?
- Is the staff not taking orders properly?
- Is there a problem in the kitchen?
- Is there insufficient equipment or ingredients?
Once he identifies the reason, he works on fixing it.
In this context, the restaurant had a standard of serving food within 15 minutes. By checking their current practices against this benchmark, they identified the gap, found the cause, and worked towards improving it.
Applying This Concept in Healthcare Settings
If we apply this concept in healthcare to improve patient care, it becomes a clinical audit.
A clinical audit involves selecting a standard and comparing current practices against it.
It helps determine whether a process aligns with the standard. If not, we identify areas for improvement — ultimately enhancing patient care.
Example of a Clinical Audit in Healthcare
-> A standard might state that when a patient is admitted to the hospital, their initial history, basic vitals, and blood investigation should be completed within 30 minutes.
To conduct an audit, we check if this standard is being followed.
- Are patients admitted to a ward having their initial history, basic vitals, and blood tests completed within 30 minutes?
- If not, what are the possible reasons for the delay?
- How can the process be improved?
The First Clinical Audit in the History — Florence Nightingale’s Story
One of the earliest and most impactful clinical audits was conducted by Florence Nightingale during the Crimean War (1853–1856).
The Problem
During the war, more soldiers were dying from infectious diseases (such as typhoid and cholera) than from actual battle injuries.
When Florence Nightingale arrived at the military hospitals, she found overcrowded conditions, poor sanitation, contaminated water, and lack of hygiene practice
She compared the current hospital conditions against basic hygiene and sanitation standards (which, at that time, were poorly followed).
She and her team introduced cleaner wards, proper ventilation, improved nutrition, handwashing, and sterilization of medical tools.
The result?
- Death rates dropped from 42% to 2% within a short time!
- She proved that better hygiene directly improved patient outcomes.
This was one of the first recorded examples of a clinical audit, where evidence-based improvements were made based on analyzing standards and practices.
Florence Nightingale’s approach in improving patient care is the foundation of modern clinical audits.
What is a Standard? Let’s Understand it for Clinical Audit
A standard serves as a benchmark or an ideal target for a process. It represents how things should ideally be done.
In a clinical audit, we use a standard to assess current practices.
Where Can You Choose a Standard for a Clinical Audit?
There are no strict rules about where to obtain a standard. You and your clinical audit team can choose an appropriate standard.
Possible sources include:
- Hospital Policies → You can use your hospital’s or institute’s policies and compare current practices against them.
- National Guidelines → You can adopt national guidelines or national standards.
- International Standards → You can use international standards such as: WHO Standards, American Guidelines, NICE Guidelines, JCIA or ISO Standards
- Research Articles → Standards can also be drawn from reputable research articles.
The key point is that the chosen standard should be acceptable to your audit team and serve as a reliable benchmark for assessing current practices.
Are Standards Always Followed?
Even though standards exist for everything in healthcare, they are not always followed.
This is because multiple people, steps, and procedures are involved in patient care, making the process complex.
This is why clinical audits are conducted — to ensure that these standards are being met.
On What Areas Can We Do a Clinical Audit?
A clinical audit can be conducted in any area of the healthcare system — administrative or clinical — that directly or indirectly improves patient care.
Examples of Clinical Audits
Clinical Aspects
- Length of stay
- Clinical management
- Clinical diagnosis
- Clinical skills
- Clinical education
Patient Experience
- Patient satisfaction
- Admission process
- Discharge process
Operational Processes
- Billing process
- Inpatient and outpatient care
- OT (Operating Theater)
- ER (Emergency Room)
- Radiology
- Dental services
- Waste management
The key point is that a clinical audit can be performed on any component of the healthcare system that needs improvement.
After all, the goal of a clinical audit is to enhance the overall health system.
It is up to you, your team, and your supervisor to determine the specific area for a clinical audit.
NOTE: Not All Audits in Healthcare Are Clinical Audits!
It’s important to remember that not every audit conducted within the health service qualifies as a clinical audit.
A clinical audit is a specific process that evaluates patient care against explicit standards as part of a quality improvement cycle.
Other Types of Audits in Healthcare:
🔹 Financial Audit — Focuses on financial records, budgets, and expenditures.
🔹 Internal Audit — Evaluates overall operational efficiency and regulatory compliance. etc
Why Are These Not Considered Clinical Audits?
Because they do not directly assess or improve patient care.
A clinical audit always revolves around patient care, treatment, and clinical outcomes, ensuring continuous improvement in healthcare services.
Key Purpose of a Clinical Audit
A clinical audit is not just about data collection. The primary purpose is to improve the process.
Act Now! Identify one area in your healthcare setting that needs improvement. Discuss it with your team. Start small, but start today. Because every audit you conduct, every process you refine, brings us one step closer to safer, more effective, and patient-centered care.
What’s Next?
In the next separate blogs, will explain:
- The steps involved in a clinical audit
- The audit cycle (loop of audit)
- How to determine the sample size
- How to write a clinical audit
Leave Your Thoughts!
✅ Thank you for reading and engaging. Stay tuned for the next one!
If you have any questions or insights, feel free to drop a comment below — I’d be happy to discuss and clarify!
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