| The Royal College of Anaesthetists’ National Audit Project (NAP) programme has been running since 2003. The foci of the last four NAP projects have been: major complications of central neuraxial blocks (NAP3)1 ; airway management related serious adverse events in the operating theatre, emergency department, or ICU (NAP4)2,3; awareness during intended general anaesthesia (NAP5)4 ; and life-threatening perioperative anaphylaxis (NAP6).5e10 An important feature of the NAPs has been the extensive engagement of anaesthetists throughout the UK (and Ireland in the case of NAP5), and the promotion of multidisciplinary and crossorganisational collaborations.11 Towards the end of the last millennium, a strong emphasis emerged in the UK on the conduct of clinical audit projects in medical practice. This focus on audit was occurring concurrently with major structural changes in medical training programs, under the banner of Calman and other reforms.12 With shorter training duration, decreased work hours, and increased stress on obtaining specific clinical competencies, many trainees chose to demonstrate scholarship by conducting well-circumscribed and modest audit projects rather than more challenging, expensive, and time consuming clinical research. At the time, Wilson and colleagues13 suggested that the motivations and the objectives of a project could help to distinguish audit from research. They proposed that ‘audit has the objective of directly improving services against a standard; research may include the objective of defining best practice.’ ۱۳ This assumed that there was a clear dichotomy between audit and research. But it is probably more helpful to view rigorous audit on the spectrum of translational research, which encompasses a continuum from the basic science laboratory to population health (Fig. 1). The processes of audit and feedback span the disciplines of observational research and implementation science, and when successful, assist clinicians in incorporating evidence-based medicine into their practice.14 Audit is part of a broader quality improvement process seeking to improve patient care and outcomes through scrupulously assessing the existing care against established knowledge and best practice, and then implementing evidence-based changes.15 To confirm the success of the audit process, it is necessary to close the loop by re-auditing in order to corroborate that the recommended changes have indeed been implemented. The process of audit is a fundamental aspect of the work of the National Institute for Health and Care Excellence (NICE), which was established in the UK in 1999. NICE has as its core mission the improvement of outcomes for people using the NHS and other public health and social care services. This is achieved through: (i) producing evidencebased guidance; (ii) development of quality standards and performance metrics; and (iii) provision of information services. |
