Principles for Best Practice in Clinical Audit

Principles for Best Practice in Clinical Audit National Institute for Clinical Excellence Published in 2002 by Radcliffe Medical Press Ltd, Abingdon, UK 208 pp. ISBN 1 85775 976 1 (paper) Price £29.95. This book (and the CD which comes with it) is aimed at leaders of local clinical audit in the UK National Health Service (NHS). The principal authors have contributed experience from three established national authorities (Royal College of Nursing, Department of General Practice at University of Leicester, and the National Institute for Clinical Excellence); they have also drawn together a wealth of supporting evidence and sources from bibliography and the internet. The main body of the text traces five stages of the clinical audit cycle: preparing for audit, selecting criteria, measuring level of performance, making improvements, sustaining improvements. Evidence is given to support key messages about audit methods and organisation, together with specific examples—and, of course, references. The appendices, which occupy two-thirds of the pages, include a 60-page ‘review of evidence’ for effective audit methods, organisation and implementing change. This review ‘updates’ the comprehensive review by Nancy Dixon (Good Practice in Clinical Audit, 1996) but its literature search focuses on 1996–2001 and excludes non-UK evidence around the organisation and participation in audit, as if this aspect of good practice is unique to the NHS. Other useful appendices include a catalogue of NHS, College and academic web sites (including a few non-UK) which provide resources and support for particular aspects of audit; there is also a collection of recommendations for improving audit, from the report of the Kennedy inquiry into cardiac surgery in Bristol, and corresponding responses from the Department of Health nodding agreement. For anyone struggling to sustain and develop audit for clinical governance in the UK NHS, this is a rich source of evidence, examples and today’s jargon, web sites and institutions, but it says little about yesterday or tomorrow. The pioneers of audit in the UK, such as Alison Kitson, Brendan Devlin, John Lunn and Anthony Hopkins get but five mentions between them. The book is light on details of time, budgets and staff required for audit locally. It makes little reference to the national confidential enquiries, and none to the Clinical Standards Board or surgical mortality survey in Scotland; maybe that is because local audit coordinators do not run these, even if they have to integrate them with local programmes. For anyone outside the UK NHS (as are most readers of this journal), principles for best practice in clinical audit would include some analysis of the evidence for and effectiveness of the national programme which began in the early 1990s. If the retrieval of ‘evidence’ had gone back more than 5 years, it would have shown that almost all the recommendations of the Bristol inquiry had already been made by the departments of health nearly 10 years earlier, for example that audit should be mandatory, multidisciplinary and nationally coordinated; that clinical and administrative databases should be integrated, and attention given to coding and data quality; that audit skills should be prominent in the curriculum, teaching and examination of all stages of clinical development. However, this book is not intended for national policymakers or an overseas market but it should be available to any local audit coordinator in the UK NHS, in hospital or primary care, because it brings together a wealth of practical and current information for clinical audit. The cover price is a fraction of the potential savings on chasing wild geese.