There are various definitions available for audit but one of the most common 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’. Audit is so ubiquitous in healthcare that it is easy to forget that it is a relatively new innovation. The concept for audit was first mooted in the 1970s. With the publication of the 1989 White Paper ‘Working for Patients: Medical Audit Working Paper No. 6’, detailed plans for a comprehensive system of medical audit within the internal market were proposed. A massive drive to develop medical audit began. Protected funding was made available to support it. With the advent of clinical governance in the mid 1990s, audit is now firmly established as an integral part of healthcare delivery.

Audit can encompass managerial and financial components of the healthcare delivery process, but the most relevant to clinicians is clinical audit. Clinical audit is essentially a checking process to assess the quality and effectiveness of any aspect of healthcare delivery and making change or improvements where necessary. It is usually described as an audit cycle. The audit cycle encompasses identifying a clinical area or objective to be audited, agreeing the standard or benchmark for the audit (minimum level of acceptable performance), data collection that describes or measures current performance, analysing the results and identifying the areas for change or improvement and, lastly, re-auditing after the change has been implemented. Clinical audit can be retrospective or prospective. Retrospective audit is probably of most use in the event of critical incident (serious untoward incident resulting in severe morbidity or death) or when a complaint or litigation has arisen and a review of practice is required urgently. In the development of any clinical audit programme retrospective audit may have a role but, for audit to contribute meaningfully to improving quality of care, the majority of clinical audit should be prospective. Prospective clinical audit allows for accurate contemporaneous collection of data reflecting current rather than historical practice. Data is therefore more likely to be accurate in volume and detail.