Clinical Audit as Evidence for
Dr David Scott, GMC Associate, Consultant
Paediatrician and Clinical Lead for Children’s Services,
East Sussex Healthcare NHS Trust
Former Chairman BMA CC Medical Managers Sub-
Topics to be Covered
• assessing the evidence for revalidation:
how much of the information should be
provided by the Trust and how much by
• how do you evidence both participation
and reflection on clinical audit findings?
Topics to be Covered
• clinical auditing your practice to provide
evidence for revalidation
• the role of clinical audit staff in
supporting clinicians to prepare for
• supporting individuals to prepare for
Purpose of revalidation
• To confirm that licensed doctors practice in
accordance with the GMC’s generic
• For doctors on specialist/GP register, to
confirm that they meet the standards
appropriate for their speciality (recertification)
• To identify for further investigation, and
remediation, poor practice where local
systems are not robust enough or do not exist
• 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
The Standards (Explicit Criteria)
• Professional – standards that are set
for the profession that determine a
registrant’s ‘fitness to practise’.
• Subjective – the patient’s point of view.
• Objective – those facts that are
observable and measurable by a nurse
or other clinician.
Good Medical Practice
– Knowledge, skills
– Safety and quality
– Maintaining trust
Types of Supporting
Information for Revalidation
• Continuing Professional
• Quality improvement
• Significant events
• Feedback from
• Feedback from patients
• Review of complaints
History of Audit
• 1956 - medical audit.
• 1989 - Kenneth Clarke, then Secretary
of State for Health: “systematic, critical
analysis of the quality of medical care,
including the procedures used for
diagnosis and treatment, the use of
resources, and the resulting outcome
and quality of life for the patient.”
Clinical Audit Project (1)
1. Registration of project
– Agreement of criteria for comparison
– Lead auditor should be named.
– There should be an entry referring to the size of
the impact, the trigger, and the desired
performance, and a credible (named) source.
– The presentation date and venue will be decided
at this stage.
– An audit reference number should be issued.
Clinical Audit Project (2)
2. Data are made available. The lead auditor
should describe the methodology of
inclusion and exclusion criteria and lost
data. This technique should mirror the
rigour of data handling in research projects.
3. Data analysis and interpretation. Statistical
methodology should be made clear.
Clinical Audit Project (3)
4. Presentation of the project, with
recommendations for implementation.
5. Trust certification of completed audit should
be provided to all participants.
6. Incorporation of the findings from the project
into a protocol should be considered.
7. Registration for re-auditing, as per (1.)
Health Quality Improvement Partnership http://www.hqip.org.uk
Clinical Audit and Revalidation
• What activities can be
considered clinical audit.
• Principles for the use of clinical
audit in revalidation
• Criteria and key indicators for
demonstrating involvement by a
doctor in the process of clinical
• Criteria and key indicators for
demonstrating reflection and
action in response to the results
of clinical audit
• Agree the criteria and indicators
of a good clinical audit project.
Audit Standards - Revalidation
• Participation in High Quality Clinical
• Reflection on the results of Clinical
• Taking action on the results of Clinical
Academy of Medical Royal Colleges (2009)
Trust Audit Programme
• Audit meetings • Risk management
• Mortality and meetings
morbidity meetings • National audits
• Serious case relating to your
• Root cause analysis • Medical record
• Professional review • Peer review
National Audit Projects
Medical Record Audit Tool
Evidence of participation
Activity Standard Evidence
Attendance at meetings Attend 2/3 meetings Meeting Register
Audit presentation Presentation at Audit Copy of presentation
Medical record review RCP standards Audit report
Serious case reviews Internal/external Copies of anonymised
Peer reviews NICE Guidance, Extracts from reports
Protocols & guidelines
Out-patient clinic Peer opinion Reflections on case
Feedback from Colleagues
Feedback from Patients
• Contributory factors
Performance of Doctors
Adapted from : Birch K, Scrivens E & Field S (1999)
“I shut my
eyes in order
Paul Gaughuin (1848-
The Role of Clinical Audit
• Support and advice
• Manage database of
• Arrange and support
• Participate in
Support for Revalidation
• Activity data
• Outcome data
• Complication rates
• Mortality & morbidity
• Serious incidents
• Patient satisfaction
• Participation in an enhanced
appraisal process combined with
effective audit of your clinical
practice should satisfy and
reassure patients, lead to greater
job satisfaction and a
recommendation for revalidation.
• Academy of Medical Royal Colleges. Clinical Audit
and Revalidation - Report and Recommendations.
• Royal College of Physicians. What is meant by
‘clinical audit’ for the purposes of revalidation?