Planning a Clinical Re-audit: A Practical Guide

Re-audits are essential for confirming sustained improvements following an initial clinical audit and implementing changes. This guide provides practical steps for planning and executing an effective clinical re-audit.

Why this topic matters

Initial audits are valuable for identifying areas where clinical practice deviates from standards. However, the true measure of success lies in whether the identified issues have been addressed and improvement sustained. This is where the re-audit becomes indispensable. Without a re-audit, it's impossible to confirm the effectiveness of interventions, to demonstrate a lasting change in practice, or to ensure that new problems haven't emerged. For clinicians and NHS teams, robust re-audits provide evidence of improved patient outcomes, support continuing professional development, and are often required for CQC frameworks, revalidation, and departmental governance.

The Audit Cycle and the Role of Re-audit

The clinical audit cycle is well-established:

Select topic and define standards: Choose a relevant aspect of care and identify clear, measurable standards (e.g., from NICE guidelines, Royal College recommendations).
Collect data: Gather data on current practice.
Compare performance against standards: Analyse the collected data.
Implement changes: Develop and put into practice interventions to address identified gaps.
Re-audit: Repeat the audit process to assess if changes have led to sustained improvement.
Sustain and monitor: If standards are met, monitor to ensure continued adherence; if not, further action is needed.

Re-auditing directly closes the audit loop, providing objective data on whether the intervention has worked. It allows for reflection, further refinement of practice, and contributes to a robust quality improvement culture.

Practical explanation of a re-audit

A re-audit should ideally mimic the initial audit as closely as possible to allow for direct comparison. This means using the same patient cohort definitions, data collection methods, and audit standards. However, a re-audit is not just a copy-paste exercise; it requires careful planning to ensure it effectively addresses the changes made.

Key considerations for a re-audit

Timing: When should the re-audit be conducted? It needs to be long enough after interventions for changes to have become embedded, but not so long that the data becomes outdated or staff turnover obscures the impact. Typically, 6-12 months is a reasonable timeframe, depending on the intervention and clinical cycle.
Scope: Does the re-audit cover the exact same scope (e.g., patient group, time period, clinical activity) as the initial audit? Deviations should be justified.
Intervention Effectiveness: The re-audit's primary goal is to assess the impact of the interventions. Ensure your data collection will capture information relevant to this.
Sustainability: Beyond showing initial improvement, a re-audit helps gauge the sustainability of changes. Are the new practices truly embedded?
Broader Impact: Consider if there have been any unintended consequences or knock-on effects from the interventions that the re-audit might unearth.

Common pitfalls in re-auditing

Inconsistent methodology: Changing data collection criteria, sample size, or standards can make direct comparison with the initial audit impossible or misleading.
Insufficient time between audits: Re-auditing too soon means interventions may not have had enough time to embed, leading to false negatives.
Lack of clear interventions: If the initial audit didn't lead to specific, measurable, achievable, relevant, and time-bound (SMART) interventions, the re-audit has no clear impact to measure.
'Audit fatigue': Teams might feel overwhelmed by repeated audits. Clear communication of the 'why' and demonstrating the positive impact of previous audits can mitigate this.
Ignoring poor results: If the re-audit shows no improvement, or even deterioration, it's crucial not to simply shelve the results. This indicates further analysis and different interventions are needed.
Poor documentation: Without clear documentation of the initial audit, including methodology and interventions, planning a consistent re-audit becomes challenging.

Step-by-step approach to planning a re-audit

Step 1: Review the Initial Audit

Before doing anything else, thoroughly review the original audit report. Pay close attention to:

Audit topic and aim: What was being audited and why?
Standards: What criteria were assessed?
Methodology: How was data collected? What was the sample size and time frame?
Key findings: What were the main areas of non-compliance?
Implemented interventions: What specific changes were put in place to address the findings?
Baseline data: This is your reference point for comparison.

Step 2: Define the Re-audit Aim and Standards

The primary aim of the re-audit is to assess the impact of implemented changes on the previously identified areas of non-compliance against the same standards. Your aim should explicitly link to the interventions and the original audit. For example: "To re-audit compliance with [Standard X] following the introduction of [Intervention Y] at [Department Z]."

Step 3: Determine Methodology (Maintain Consistency)

Patient cohort/inclusion criteria: Use the exact same criteria as the initial audit.
Time frame: Select a similar duration for data collection as the original audit, ensuring it's sufficiently after the intervention period (e.g., if the original was 3 months, re-audit for 3 months).
Sample size: If feasible, aim for a similar or larger sample size. If the population is small, you might need to audit 100% of cases over the period.
Data collection tools: Use the same data collection form to ensure direct comparability. If minor amendments are essential (e.g., to capture impact of specific new interventions), clearly document these and justify why previous measures might still be comparable.
Data sources: Maintain consistency (e.g., electronic patient records, paper notes, observation).

Step 4: Plan for Data Collection and Analysis

Secure necessary permissions: As with any audit, ensure you have local clinical audit department approval and understand any information governance requirements.
Logistics: Who will collect the data? How will it be stored securely and anonymised/pseudonymised if necessary? When will it be collected?
Analysis: Plan to compare your re-audit results directly with the baseline data from the initial audit. Visualising the 'before' and 'after' data (e.g., using bar charts) is often very effective.

Step 5: Report and Disseminate Re-audit Findings

Compare results: Clearly present the initial audit results alongside the re-audit results.
Interpret findings: Has the intervention worked? Has practice improved? Is it sustained? Are there new areas of concern?
Recommendations: Based on the re-audit, what are the next steps? If improvements are seen, how will they be sustained? If not, what new interventions are needed?
Dissemination: Share the findings with all relevant stakeholders – staff involved in the original audit and interventions, departmental leads, governance committees, and potentially wider organisational forums. Transparency is key to embedding a culture of improvement.

Step 6: Plan for Sustainability or Further Action

If the re-audit demonstrates sustained improvement, celebrate the success and consider how to embed these changes into routine practice. This might involve updating local policies, integrating new processes, or providing ongoing training. If targets are still not met, the re-audit provides evidence that further, perhaps different, interventions are required, looping back into the audit cycle.

Example in clinical practice: Management of Sepsis Screening

Initial Audit (Year 1):

Topic: Compliance with local sepsis screening and early management bundle in A&E.
Standard: 95% of patients presenting with suspected infection or meeting SIRS criteria should have a full sepsis screen completed within 30 minutes of triage.
Finding: Only 60% compliance observed.
Intervention: Introduction of a mandatory e-learning module for all A&E staff, redesign of the triage screen in the EPR to include prominent sepsis prompts, and daily morning huddle discussions on recent sepsis cases.

Re-audit Planning (Year 2):

Review Initial Audit: Accessed the initial audit report, noting the exact inclusion criteria (all adult A&E admissions over a 1-month period with relevant ICD-10 codes), data points collected, and the 60% baseline compliance.
Re-audit Aim: To assess compliance with the local sepsis screening and early management bundle in A&E following the implementation of the e-learning, EPR prompts, and huddle discussions.
Methodology: Repeat the audit for a 1-month period, 9 months after interventions began, using the exact same data collection tool from the EPR. Sample size aimed to be similar (e.g., 200 patients).
Data Collection & Analysis: Data collected by junior doctors and a QI nurse, anonymised, and analysed using a simple spreadsheet comparing the Year 1 vs Year 2 compliance rates.
Reporting: Findings presented at the monthly A&E governance meeting.

Re-audit Result: Compliance had risen to 88%. This showed significant improvement, demonstrating the effectiveness of the interventions. While not hitting 95%, it allowed for further discussion on the remaining gap and identified specific areas for further refinement, keeping the audit cycle moving.

How Lazomis can help

Lazomis provides a structured environment to manage your audit projects, from initial setup through to re-audit planning and reporting. Our platform allows you to:

Store initial audit details: Keep your original audit aims, standards, methodology, and results securely organised, making it easy to access when planning your re-audit.
Build consistent data collection forms: Reuse or easily adapt existing forms to ensure consistency between your initial audit and re-audit data collection.
Track intervention impact: Document your interventions and link them directly to specific audit findings, setting the stage for evaluating their effectiveness in the re-audit phase.
Generate comparative reports: Lazomis can help visualise the 'before' and 'after' data, making it straightforward to compare initial audit results with re-audit findings.
Support dissemination: Easily export reports and share findings with your team and other stakeholders.

Lazomis helps streamline the administrative burden of audit, allowing clinical teams to focus more on the critical analysis and implementation of change. This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.

How to Plan a Re-audit Effectively