The components of audit

Audit is traditionally viewed as a loop, the components of which are structure—process—output. The term structure refers to the physical environment in which healthcare is provided; process refers to the activity of providing care; and output to the outcome of that care both for the individual and for the community as a whole. The loop is completed by the output feeding back on potentially both structure and process. Table 71.1 summarises what is needed to provide a quality service — structure, process, outcome data and feedback.

Both a quality service and an audit cycle need the feedback loop to be effective. The loop must be viewed as an unending sequence. Moreover, it is implicit in the definitions that a single clinician cannot perform audit alone; teamwork with finance managers and other clinical staff, etc., is obligatory.

All aspects of clinical audit must be compared with some form of standard and then retested against the standard on the next loop of the cycle. It is generally accepted that as far as specific surgical techniques are concerned the comparison must be against properly constructed prospective randomised clinical trials. Other independent and objective standards must be established for other comparisons.