Clinical audit – process and outcome for improved clinical practice

Clinical audit as a construct is embedded in the healthcare provision within the United Kingdom but has its origins in the Crimean War from 1853–1855. Florence Nightingale, an unknown British nurse at the time, noted the ‘unsanitary conditions’ and ‘high mortality rates’1 amongst injured soldiers at the medical barracks hospital in Scutari 1853. In response to these observations, she recruited a team of nurses to introduce strict cross-infection control measures within the hospital, as well as keeping records of relative mortality rates amongst the soldiers. This change of hygiene and sanitary procedures within the hospital led to a decline in mortality rates from 40% to 2%1, and was instrumental in helping improve the quality of care within the hospital environment. This is one of the earliest examples of ‘outcomes management’.1

Another advocate of improving the quality of patient care utilizing an ‘end results outcome’2 approach was Ernest Codman, a pioneering and dedicated surgeon in Massachusetts in the 1890s. He was a firm believer in analysing clinical ‘misadventures’2 and studying hospital outcomes, as well as how they could be improved. He developed his own hospital in the early 1900s, where he followed the progress of a large number of his patients through their recoveries ‘within a systematic manner’2 via a series of ‘end result cards’.2 This led him to establish an ‘end results system’2 which led to an improvement in patient care.