2Q1. Who allegedly carried out the first ever clinical audit? A Dr FosterB Mary SeacoleC HippocratesD Florence NightingaleThe answer is D – Florence Nightingale. However, there is some debate over whether her work represented a conventional clinical audit as initial criteria/standards were not agreed.
3A Search for literature B Data collection C Data analysis Q2. Which part of the clinical audit process follows devising criteria and standards?A Search for literatureB Data collectionC Data analysisD Implement necessary changesThe answer is B – Data collection
4A Poor B Mixed C Good D Excellent Q3. According to a statement from NICE in the Principles for Best Practice in Clinical Audit (2002) – “Clinical Audit has a ____ history in the NHS”A PoorB MixedC GoodD ExcellentThe answer is B – Mixed. Principles for Best Practice in Clinical Audit was first published in 2002 and the quote comes from page ix (NICE foreward). This question acknowledges that not all clinical audit has been useful and led to the Chief Medical Officer stating in 2007 that ‘clinical audit needs to be re-invigorated’.
5Q4. Which term do you associate with clinical audit? A Sydney EffectB Hawthorne EffectC Melbourne EffectD Errinsborough EffectThe answer is B – Hawthorne Effect. The Hawthorne Effect is highly relevant to clinical audit as it suggests that subjects improve or modify their behavior as a result of being observed. Therefore, if clinical audit is carried out prospectively and subjects are made aware that they are being audited (e.g. handwashing audits) they are likely to amend their behavior and potentially bias results. Retrospective clinical audit will not be impacted by the Hawthorne Effect – so this is an important consideration and discussion point in terms of how clinical audit projects are set up. N.B. The term is credited to Henry A. Landsberger.
6Q5. Which of the following is NOT a type of clinical audit? A Process AuditB Financial AuditC Outcome AuditD Structure AuditThe answer is B – Financial Audit. Most clinical audits in the UK look at elements of structure, process and outcome (or a mix of the three). A structural audit might involve looking at resources available/staff skills, a process audit typically focus on what is done to the patient and outcome audit looks at the impact of the care/intervention. Financial audit is not a type of clinical audit, although it is interesting to note that in recent years there is increasing pressure to conduct clinical audits that save money and resources. N.B. The structure, process, outcome model is credited to Avedis Donabedian.