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863 Demystifying Clinical Audit Gayle Hartigan Audit Development Officer, CSI’ The concept of auditing clinical practice, as a system- atic method of improving the quality of patient care, was introduced in 1989 as part of the NHS reforms. However, the results of a recently-published national evaluation of medical and clinical audit by CASPE Research reveal that, while medical audit programmes have been established in virtually all provider units in England, progress towards multi-professional clinical audit has been limited, and difficulty has arisen in ensuring coverage and equity in the allocation of audit funds to all the health care professions. The Department of Health recognises that different approaches to auditing have been adopted by different professions and it is acknowledged that these varying approaches and individual professional sensitivities should be recognised and respected in the move towards multi-professional, clinical audit. An ongoing initiative to fund the establishment of audit leads in the non-medical colleges and professional bodies aims to redress any potential imbalance between profes- sions with regard to obtaining auditing skills and experience, and to help in providing equal accessibility to audit training and resources for all health care pro- fessionals. In March 1994 the CSP made a successful bid to the Department of Health for funding to support the establishment of a clinical audit lead within the Society and, in September, an audit development offi- cer was appointed on a one-year fixed-term contract, to develop clinical audit focused upon the work of chartered physiotherapists. Her r81e will include car- ryir,g out a mapping exercise, on behalf of the CSP, to determine the current levels of involvement and progress in clinical audit throughout the profession; production of a CSP Clinical Audit Pack containing practical information on clinical audit planning, methodologies and execution; organisation of training days and workshops in clinical audit; and providing a focus for members to obtain practical advice and guid- ance on all aspects of clinical audit activity. It is also planned to set up a database at the CSP of chartered physiotherapists with knowledge of, experience or an interest in clinical audit which could form the basis for a national network of clinical auditors within the physiotherapy profession, to promote the exchange of ideas and methodologies and the sharing of clinical audit information. Despite the relatively large expenditure on clinical audit since 1989 and the proliferation of a vast num- ber of publications, journals and distance learning packages, confusion continues to exist regarding the precise definition of‘ clinical audit, the way in which it differs from research and, in particular, whether it can be applied uni-professionally within the therapy pro- fessions. In November 1994 the CSP sought clarifica- tion from Mr Sean Brennan, clinical audit adviser to the Department of Health, and the following extract is reproduced from Mr Brennan’s reply (CSP italics): ‘When the Department refers to the Clinical Audit programme, it is using the term in its generic form, ie to describe any audit undertaken by any clinician. This might be performed in uniprofessional groups, either because that is a more appropriate approach to a particular topic or during the early developmen- tal stages of audit within a profession within a unit, or in a multi-professional group.’ Clinical audit differs from research in that research seeks new knowledge and understanding, whereas clinical audit is a method of examining the use of existing practices and associated resources in a specif- ic setting, and determining whether there are areas where improvements can be made. Research and clini- cal audit can serve to strengthen each other on a mutual basis, in that clinical audit may highlight a need or desirability for changes to current practice, either by incorporation of research findings, or by local problem solving which, in turn, may identify pertinent areas for research. The required changes are usually written up in the form of a local protocol and clinical audit becomes the tool by which implementation of the new practice can be monitored. Because improvements are made using existing local resources, the results of clinical audit can be applied only within the specific setting where the audit was carried out. However, publication of the aims, methodology and results of clinical audit is an effective way of sharing clinical information throughout a profession; similar audits could be carried out in different settings, and research projects could be initiated on the basis of audit results. Although physiotherapists may have been mostly involved in clinical audit on a multiprofessional basis as part of a health care team, there are many areas where clinical audit could be applied uni-profession- ally within the physiotherapy profession. For example, physiotherapists could examine the appropriateness of a range of interventions which may be used to treat patients with a specific diagnosis and, by comparison of the outcome for patients, determine which interven- tions are most effective. Uni-professional clinical audit is facilitated by estab- lishment of a local audit group within the physiothera- py service/department so that clinical practice is audited on a systematic basis with findings discussed by peer review and shared by the physiotherapy ser- vice as a whole. The establishment of such a frame- work for clinical audit at service/dcpartmental level need not require large investments of either time or Physiotherapy, December 1994. vol80, no 12
