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Cochrane Collaboration systematic reviews of clinical audit used the term ‘audit and feedback’.  But audit does not end with feeding back data. ‘Audit’ meant collecting data to compare practice against standards, and ‘feedback’ meant sharing the results with professionals. Modern published accounts of clinical audit do not support this interpretation.

 

In 2001, the National Institute for Health and Care Excellence (NICE) defined clinical audit as a quality improvement process. The first journal article on medical audit, published in 1967, described involving professionals whose practice needed to improve as the action. In 1971, Brown and Fleisher presented audit as a by-cycle model in which audit findings became the basis for planning and delivering an educational programme. They also included organizational change as part of the second cycle of the audit process.

 

When the US Joint Commission introduced clinical audit into hospital accreditation standards in 1974, it described the second stage as identifying problems revealed by audit data, determining their causes, and taking action to address them. The process was never limited to ‘feedback’.

 

Numerous researchers have uncritically adopted the Cochrane phrase to describe audit. It is time to recognize audit for what it is: an improvement process.