Mesurement Quality

Clinical Audit

Clinical audit 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”.

The key component of clinical audit is that performance is reviewed (or audited) to ensure that what should be done is being done, and if not it provides a framework to enable improvements to be made.


One of first ever clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853-1855. On arrival at the medical barracks hospital in Scutari in 1854, Florence was appalled by the unsanitary conditions and high mortality rates among injured or ill soldiers.

She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment, and with Florence’s gift with mathematics and statistics, kept meticulous records of the mortality rates among the hospital patients.

Following this change, the mortality rates fell from 40% to 2% and were instrumental in overcoming the resistance of the British doctors and officers to Florence’s procedures. Her methodical approach, as well as the emphasis on uniformity and comparability of the results of health care, is recognized as one of the earliest programs of outcomes management.


Standards-based audit

A cycle which involves defining standards, collecting data to measure current practice against those standards, and implementing any changes deemed necessary.

Pt. surveys and focus groups

These are methods used to obtain users’ views about the quality of care they have received. Surveys carried out for their own sake are often meaningless, but when they are undertaken to collect data they can be extremely productive.

Peer review

An assessment of the quality of care provided by a clinical team with a view to improving clinical care. Individual cases are discussed by peers to determine whether the best care was given. Unfortunately, some of the recommendations made from these reviews are not pursued as there is no clear systematic method to follow

Adverse occurrence screening 

This is often used to peer review cases which have caused concern or from which there was an unexpected outcome. The multidisciplinary team discusses individual anonymous cases to reflect upon the way the team functioned and to learn for the future. In primary care setting, this is described as a ‘significant event audit’.

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Dr. Khalid Abulmajd

Healthcare Quality Consultant

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