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Quality and safety


Clinical audit

Clinical audit

Clinical audit is the review of clinical performance against defined standards and the refinement of clinical practice as a result. All networked sites should have an annual multidisciplinary audit plan. Precedence should be given to high priority audits which should include detail about how provider staff will interact with host clinical audit activities and vice versa. Network-wide audits should be encouraged to enable quality benchmarking to highlight best practice and where this might be shared to improve clinical outcomes.

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  • Audits should be performed according to the audit policy using standardised proposal and reporting templates, include a clear SMART (specific, measurable, achievable, realistic, timely) action plan with leads identified for each action, involve all stakeholders and be registered with the audit department.
  • Re-audits should be scheduled and completed.
  • Progress and results of audits should be presented at the clinical governance sessions and actions agreed. Learning should be shared across the network.
  • The following audits should be mandatory at least annually across all relevant sites:
    • % success of X operation.
    • % infection post X operation.
    • % complications post X treatment.
    • % adherence to X national guidance.
    • % adherence to X local policy.

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