HOW TO WRITE AN AUDIT REPORT

							How to write an audit report

What should be in a clinical audit report?

Clinical Audit reports should include:

Front page
    •   Name of the organisation and name of division/specialty
    •   Project title
    •   Project lead/s (and name of the person who wrote the report, if different)
    •   Date of report

Table of contents - recommended if report runs to more than eight pages

Executive summary
It is good practice to begin a report with an executive summary (or ‘abstract’). This should be a
short paragraph (certainly no more than 10% of the total length of the report) that
encapsulates the main thrust of the report. Identify the issue, state the key findings,
conclusions and what course of action is recommended. This will help people identify whether
they need to read the full report, and will be a useful précis for busy managers. You may
(instead of or in addition to an executive summary) want to produce a one A4 page summary of
the report for this purpose, especially if the report is very long.

Background
This is essentially narration, clarifying why the audit was done. For example, was the project
prompted by an identified local problem or concern? The background should explain the
rationale for doing the audit, i.e. why this topic is a priority for quality improvement. Summarise
the evidence base for the audit topic, giving full references at the end (see point 12). If you
convened a team to undertake thisaudit, this is a good point to say how this was organised and
who was involved.

Objectives
These explain what the project is trying to achieve and should have been identified at the start.

Standards
Assuming you are measuring against standards, guidelines or benchmarks of some sort, you
need to state what these are (using the criteria/target/exception format, as detailed in ‘How to
set audit objectives and standards’) and where they come from (the source and strength of
evidence). State if the intention was to set standards at the end of the project and if so, which
aspects of care those standards pertain to.

Methodology
State your chosen population for this study (e.g. “patients referred to the one-stop breast clinic
for suspected cancer”) and then go on to say how you selected the sample for your audit,
specifying whether a retrospective or prospective methodology was used (e.g. for a prospective
audit, “the first 100 patients referred to the clinic starting from 1/10/04”, or for a retrospective
audit, “all patients seen at the outpatient clinic during July 2004”).

Describe how these patients were identified, e.g. which ICD10 or OPCS4 codes were used.
State the size of your sample and the time period, and clarify how this was calculated or agreed

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upon. The data collection method should also be stated, e.g. “Data was collected from patients’
case notes using an audit pro-forma (see Appendix A)”. Also state who was responsible for data
collection and when this was done, and mention briefly the method of data input (if
appropriate) and analysis.

Results
State how many subjects (e.g. patients) were included in the audit. This is your initial ‘n’
number. If your data is incomplete, explain why, e.g. you might not be able to find every set of
patient notes. How you analyse your data depends upon the question/s you want to answer.
Ensure you include the number and percentage of cases meeting each standard, making it clear
what number you are taking a percentage of as your ‘n’ number may change at different points
of the report, e.g. 45/50 (90%). If you use a statistical test (e.g. Chi Square) to analyse data,
state clearly what the test is and whether the results are statistically significant.

Data may be presented as tables or as a chart. Be selective in your use of charts – only
illustrate the key findings in this way so as not to overburden readers. Use the most appropriate
chart for each piece of data, e.g. pie charts to show proportions, or bar charts for easy
comparison between different areas or standards. Quote both raw figures & percentages in the
chart where possible. Where you can only have one or the other, pie charts should have the
raw figures as a label by each segment, rather than percentages, as this chart is designed to
visually show proportions percentages).

Charts showing only percentages should be accompanied by a table showing the raw figures –
these will be needed when it comes to re-auditing and comparing results. Individual healthcare
staff should not be identifiable in your report - audit should not be used as a ‘witch hunt’. If, for
example, you are comparing the results of three consultant firms, you could call them A, B and
C. Have the decoder handy though - clinicians may wish to identify themselves! Patients should
also not be identified, for confidentiality reasons.

Conclusions
List the key points that flow from your results - use bullet points and avoid long paragraphs.
Ensure your conclusions are supported by the data, or if your data points to no firm
conclusions, say so - don’t make claims that are not supported by the evidence. Make objective,
factual statements, not subjective ones, i.e. don’t say “it is obvious that…” or “clearly, what is
happening is…”

Recommendations
Where appropriate, recommendations for change should be made. Make sure these are realistic
and achievable. If you need money to implement recommendations, have you got access to any
suitable funds?

Action Plan
When your report is presented (e.g. at an audit meeting), your recommendations will either be
accepted or revised. Once this has been done, an action plan should be agreed (preferably at
that meeting) saying what changes will be implemented, who will be responsible for carrying
them out and when this will be done. Include this either in the body of the report, or if the
report is already written, as an addendum to the full report. If appropriate (i.e. changes are to
be made), set a date for a re-audit to complete the audit cycle.

References
The full references of the evidence base referred to in your background. Try to be consistent in
the way you reference – if you are hoping to get your project published, some journals are

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quite particular about how references are listed. The Vancouver style favoured by the BMJ and
other journals numbers references in the order in which they appear in the text. Give the names
and initials of all authors followed by the title of the article, the title of the journal, the year of
publication, the volume number and the first and last page numbers. References to books
should give the names of any editors, place of publication, publisher and year.

Appendices
Include a copy of the pro-forma/questionnaire that you used for data collection.

Tips for reports

•   Think about who is going to read your report and gear the content and style accordingly.
    With this, also think about what are you trying to achieve – e.g. if you need to persuade
    people of the need for action, make sure your report reads persuasively and puts a good
    case.

•   Make it look professional but also like something that people would want to read! Use
    colours and fonts sensibly, but be consistent. Arial is an easily readable font.

•   Your report should have a logical flow to it and all the words should be understandable. This
    will all help to make it more readable. Make the structure explicit by using section headings
    and paragraphs (numbered if necessary). Don’t forget page numbers!

•   Every word in your report should count for something. Don’t embellish your report
    unnecessarily (e.g. “With this in mind…” or “All things considered….”). An audit report
    should be largely descriptive (statement of facts), although it can sometimes be appropriate
    to include opinions and anecdotes.

•   Even if your readers understand the terms you are using, particularly abbreviations and
    acronyms, it is good practice to write these out in full in the first instance.

•   Ask someone else to proof read your report before you distribute it – you’ll be amazed at
    the mistakes you’ve missed however many times you’ve checked it yourself! This is also an
    opportunity for your proof-reader to say ‘I didn’t quite understand this bit’ or ‘this bit didn’t
    flow very well’, which gives you a chance to express yourself more clearly in the version you
    send out.

•   Start writing your report early on in the audit process - everything up to the results
    section can be written before you start collecting and analysing your data. Results etc can
    then be added in as you go along, with the report only being finalised after the action plan
    is agreed. This makes for less work at the end to finish off the project before moving on to
    some other topic!




                             Reproduced in part from information published by United Bristol Healthcare NHS Trust

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