On the clinical audit trail

Despite the expectation that clinical audit should be integral to professional practice, it’s still not happening in most physiotherapy roles. Is this due to the way physiotherapists perceive clinical audit or are there other barriers to wider engagement? Does the profession need to experience a cultural shift to appreciate fully the benefits of clinical audit and quality improvement?

My passion for clinical audit developed after a change of job, leaving NHS outpatient physiotherapy for a role involving quality assurance and clinical audit with IPRS Health, an independent health and wellbeing provider. In my new role I wanted to improve my knowledge and skills and, with the help of funding from the CSP Charitable Trust, I completed a PGCert in Clinical Audit at Keele University. 

This opportunity opened my eyes to how clinical audit could – and, more importantly, should – contribute to best practice. But it also led me to question physiotherapists’ awareness of, and involvement in, the opportunities it presents to improve practice. 

I used my work-based final module project to explore the barriers to engagement in clinical audit among colleagues, investigating their knowledge, skills, and attitudes. Not surprisingly, my findings reflected some of the barriers reported in the literature (see box). Are these genuine barriers, or myths that have become embedded in physio culture because of limited understanding and education? And, whether myth or reality, how do we overcome them?

Too often the term ‘audit’ is associated with a time-consuming, data collection task of limited relevance to patient care. But well-executed audit serves a dual role in quality, as both an assurance and improvement process, both equally vital in achieving best clinical practice.

Most physios engage in CPD activities and readily acknowledge the importance of research in improving clinical effectiveness and evidence-based care. But do they recognise the reciprocal relationship between research and clinical audit? Effective clinical audit is the ideal tool for translating research findings into practice, so driving improvements in care quality, and re-audit, is an essential but frequently forgotten part of the process. It both confirms and quantifies the improvements that directly result from changes implemented during audit, thereby assuring and measuring quality. 

The CSP’s recent publication of new standards for hip fracture rehabilitation, based on the results of the Hip Sprint audit, clearly shows how clinical audit can inform practice to foster high quality, evidence-based rehabilitation. Similarly, the CSP reported on how a physiotherapy service had used findings from the Sentinel Stroke National Audit Programme to improve outcome measures and collaborative care to benefit patients.

Once we understand why clinical audit is important, what must be in place to enable effective audit? It needs a collaborative approach, with organisations fostering a supportive environment for physios to engage with audit projects; providing clear processes, and adequate tools and resources to support successful audits. 

Organisations may have a formalised process, including access to clinical audit and quality improvement experts to facilitate audits. Unfortunately this is rare in organisations dominated by allied health professionals, particularly in smaller organisations and the private sector. Even where this structure exists, physiotherapists are not often involved. This is my current focus. My employer is supporting me to develop and deliver a framework to build clinical audit knowledge and skills among its clinicians, and to facilitate the process, thereby improving staff engagement, and working to embed audit within the normal clinical role.

Clinical audit provides a fantastic opportunity for physios to improve care and influence future services, while adding to their skills and CPD portfolio, including providing evidence of meeting HCPC standards. Within the profession, a cultural shift, or at least wider engagement and education, is key to fully integrating clinical audit within physiotherapy practice. This is clearly a challenge, but initiatives like the annual awareness week can be a springboard for inspiring more physios to champion clinical audit.  

• Linda Wilson works with  IPRS Health's clinical audit team

Barriers to engagement

Action plan to promote engagement

More information

• Visit Healthcare Quality Improvement Partnership (HQIP)  Clinical Audit Awareness Week for more information.