Reviewing audit: barriers and facilitating factors for effective clinical audit

Objective-To review the literature on the benefits and disadvantages of cli nical and medical audit, and to assess the main facilitators and barriers t o conducting the audit process. Design-A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audi t of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. Results-Findings from 93 publications were reviewed. These ranged from sing le case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between p rimary and secondary care. The studies reviewed incorporated the experience s of a wide variety of clinicians, from medical consultants to professional s allied to medicine and from those involved in unidisciplinary and multidi sciplinary ventures. Perceived benefits of audit included improved communic ation among colleagues and other professional groups, improved patient care , increased professional satisfaction, and better administration. Some disa dvantages of audit were perceived as diminished clinical ownership, fear of Litigation, hierarchical and territorial suspicions, and professional isol ation. The main barriers to clinical audit can be classified under five mai n headings. These are lack of resources, lack of expertise or advice in pro ject design and analysis, problems between groups and group members, lack o f an overall plan for audit, and organisational impediments. Key facilitati ng factors to audit were also identified: they included modern medical reco rds systems, effective training, dedicated staff, protected time, structure d programmes, and a shared dialogue between purchasers and providers. Conclusions-Clinical audit can be a valuable assistance to any programme wh ich aims to improve the quality of health care and its delivery. Yet withou t a coherent strategy aimed at nurturing effective audits, valuable opportu nities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promis e.