Evolution

Within the UK National Health Service, Medical Audit was formally introduced in 1989.1 In 1990, this was extended to nurses, closely followed by dentistry and pharmacy. In 1993, it evolved into Clinical Audit when medical, nursing and therapy audit were brought together. In 1997, with the introduction of Clinical Governance, Clinical Audit became embedded within UK professional practice.2 Clinical Audit is a quality improvement cycle that involves effectiveness measurement of healthcare against agreed proven standards. The aim is high-quality care with actions to align practice with standards to improve outcomes.3

Quality in healthcare is a multi-dimensional framework of six domains to ensure care is ‘safe, timely, effective, efficient, equitable, and cost effective’.4 Although there is no universal definition for quality improvement, it can be considered as ‘better patient experience and outcomes achieved by changing provider behaviour and organisation through systematic change methods and strategies’.5 Historically, Clinical Audit has been considered the most robust tool for change.6 Quality improvement tools include the Plan-Do-Study-Act cycle.7 There is often confusion around terminology and methodology among audit, quality improvement, research and service evaluation (table 1). 8