BHIVA Clinical Audit Faculty

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery.
National Institute for Health and Clinical Excellence.

The key difference between clinical audit and research is that research seeks to derive generalisable new knowledge, whereas audit and related activities assess how existing knowledge is applied in specific settings. The BHIVA clinical audit sub-committee uses the following table from the Central Office of Research Ethics Committees when planning its programme, which includes  service evaluation in relation to aspects of care for which no standard has yet been established:

RESEARCH	CLINICAL AUDIT	SERVICE EVALUATION
Designed and conducted to generate new knowledge	Designed and conducted to provide new knowledge to provide best care	Designed and conducted to define current care
Quantitative research - hypothesis based Qualitative research - explores themes following established methodology	Designed to answer the question: "Does this service reach a predetermined standard?"	Designed to answer the question: "What standard does this service achieve?"
	Measures against a standard	Measures current service without reference to a standard
May involve a new treatment	Doesn’t involve a new treatment	Doesn’t involve a new treatment
May involve additional therapies, samples or investigations	Involves no more than administration of questionnaire or record analysis	Involves no more than administration of simple interview, questionnaire or record analysis
May involve allocation to treatment groups NOT chosen by HCP or patient	Does not involve allocation to treatment groups: the HCP and patients choose treatment	Does not involve allocation to treatment groups: the HCP and patients choose treatment
May involve randomisation	Does NOT involve randomisation	Does NOT involve randomisation
ALTHOUGH ANY OFTHESE THREE MAY RAISE ETHICAL ISSUES, UNDER CURRENT GUIDANCE:-
RESEARCH REQUIRES R.E.C. REVIEW	AUDIT DOES NOT REQUIRE R.E.C. REVIEW	SERVICE EVALUATION DOES NOT REQUIRE R.E.C. REVIEW

Further information from the NHS Clinical Governance Support Team
General Medical Council guidance