How to Do Your First Clinical Audit as a Doctor: A Step-by-Step Guide
Many doctors are told to "do an audit" without ever being shown how. The result is often a pile of data that never leads to change, or a project the trust does not recognise. This guide walks you through a first clinical audit from start to finish, so you finish with a complete cycle you can present and put on your NHS application.
Quick answer
To do your first clinical audit, choose a narrow topic with a written standard, such as a NICE guideline or trust policy. Turn it into yes-or-no criteria with targets, register the audit with your trust's clinical audit team, then collect anonymised data from a fair sample. Calculate compliance, present the results, agree an action plan and re-audit to close the loop.
What you will learn in our free Clinical Audit and Quality Improvement: A Step-by-Step Guide course
Most NHS posts ask for involvement in audit or quality improvement. This course takes you from no experience to a project you can describe with confidence. Our free online Clinical Audit and Quality Improvement: A Step-by-Step Guide course is written for NHS doctors and international medical graduates. You study at your own pace in 4 short modules, with worked examples, interactive exercises and a short quiz at the end. There is no sign-up, and your progress is saved so you can stop and come back.
The 4 modules
The basics: Why audit and QI matter — especially for IMGs, Where audit and QI fit in the NHS, Audit, QI, service evaluation or research? How to tell, Can I do this in my home country? Yes, Audit or QIP — which should I choose?
Clinical audit, step by step: The audit cycle — the whole journey on one page, Choose a good topic, Find the standard, Turn the standard into criteria and targets, Plan your sample
Quality improvement, step by step: What QI is — the Model for Improvement, Understand the problem first, Write a SMART aim, Decide exactly what to measure, Measure the baseline
Write it up and use it: Write the report or abstract, Present it — slides and posters, Use it on your CV, Trac application and at interview, Common mistakes — and the final checklist
By the end of the course you will be able to
Explain clearly the difference between audit, quality improvement, service evaluation and research
Plan and run a clinical audit: topic, standard, criteria, targets, sample, data sheet and registration
Calculate and present results correctly, write an action plan and close the loop with a re-audit
Run a quality improvement project: SMART aim, the right measures, baseline, PDSA cycles and a run chart
Do a valid project in your home country hospital, and handle patient data safely anywhere
Write it up and talk about it confidently on your CV, Trac application and at interview
Why it helps your NHS application
Two fully worked projects, from choosing a topic to closing the loop
Do a valid audit or QIP in your current hospital — in the UK or abroad
Ready-made wording for your CV, Trac application and STAR interview answer
How to write it on your NHS application
In your CV and on NHS Jobs or Trac: list it under "Audit and quality improvement" (or in the training and courses section of the form), for example:
Clinical Audit and Quality Improvement: A Step-by-Step Guide, online CPD course, CareerPro UK. Certificate of completion, [month and year]; verifiable online, ID CP-XXXXXXXX.
In your supporting statement: show what you learned and how you use it. For example (adapt it so it is true for you):
"I completed an online course in clinical audit and quality improvement and used it to plan a re-audit of [topic] against [national standard], registered with my department's audit lead."
At interview: the course also prepares you for questions such as "Tell us about an audit or quality improvement project you have been involved in. What changed as a result?"
Your certificate of completion
When you pass the quiz, you can download a certificate pack:
A verifiable PDF certificate of completion with your name, the course, your CPD time and a QR code that shortlisters and appraisers can scan
An appraisal-ready reflective note, pre-filled with the course learning outcomes
A ready-to-paste line for your NHS Jobs or Trac application and CV, and a one-click "Add to LinkedIn" button
Studying is free. The certificate pack is a one-off £5, and you pay only after you pass
Before you start: what an audit is (and is not)
A clinical audit measures current care against an agreed standard, makes changes where care falls short, and then measures again. The Healthcare Quality Improvement Partnership (HQIP), which publishes national best-practice guidance on clinical audit, describes it as a quality improvement cycle.
The key test is the standard. If you are measuring against a written guideline or policy, it is an audit. If you are simply describing what happens, it is a service evaluation. If you are testing a new treatment or trying to produce new, generalisable knowledge, it is research. The Health Research Authority's guidance on defining research states that clinical audit does not require review by a research ethics committee, but you must still register it locally and handle patient data properly.
If you are unsure whether your idea should be an audit or a quality improvement project, our guide to clinical audit vs QIP explains the difference. The rest of this post focuses on doing the audit itself.
Step 1: Choose a topic you can finish
The topic decides almost everything else. A good first audit topic is:
Important: it affects patient safety, is common, or is costly.
Backed by a written standard: there is a guideline or policy to measure against.
Recorded: the information you need is written in the notes, drug chart or electronic record.
Practical: you can collect enough data in a few weeks alongside your rota.
Supported: your consultant and team care about it and will help make changes.
Then narrow it to one aspect of care, in one group of patients, in one place. "Antibiotic prescribing" is too broad. "Antibiotic review documented within 72 hours of starting intravenous antibiotics, in adults on the acute medical unit" is an audit you can actually finish.
Ask your consultant and the trust's clinical audit team whether they have a list of priority topics or previous audits that are due a re-audit. Repeating an earlier audit is quick and valued. If you need ideas, our free Audit & QIP Ideas tool suggests projects based on your setting, department and grade.
Step 2: Find the standard and write your criteria
Your standard should come from a trusted, written source. In the UK, that usually means NICE guidance, Royal College or specialty society guidance, or your trust's own policy. Local policies often add practical detail, such as a time limit. Record the exact recommendation, its number and the version date, and always check you are using the current version.
Next, turn the standard into criteria: precise checks that two people would score the same way from the records. Most good audits have two to five. A useful formula is: what is done or documented, by when, for which patients.
For example, NICE guideline NG89 recommends that medical patients are assessed for VTE and bleeding risk as soon as possible after admission, or by the time of the first consultant review, and that people at increased risk receive verbal and written information before prophylaxis. If your trust policy sets a 24-hour limit, a criterion could be: "VTE risk assessment is documented within 24 hours of admission for adult medical admissions."
Set a target for each criterion before you collect any data, and agree it with your consultant. Use 100% for things that must always happen and a slightly lower target where there are legitimate exceptions. Setting targets after seeing the results lets you move the goalposts, and panels notice.
Step 3: Plan your sample and register the audit
Sample. For a local audit, 20 to 50 cases is often enough to show a pattern. Use consecutive cases or all eligible cases in a set period, and never hand-pick patients. Decide whether you are looking back at past records (retrospective) or recording cases as they happen (prospective). Write down your inclusion and exclusion rules before you start, and record how many cases you exclude and why. Where possible, include nights and weekends, because that is often where gaps appear.
Registration. Before you look at a single set of notes, register the audit with your trust's clinical audit or clinical effectiveness team. This avoids duplicated work, confirms you have permission to access records for this purpose, and creates an official record you can use in your portfolio and applications. Most trusts ask for a short proposal covering:
the title, your name, grade and supervising consultant
why the topic matters
the standard and its source
your criteria and targets
your sample, period and inclusion and exclusion rules
how you will keep data anonymous and where you will store it
where you will present and when you plan to re-audit
Save the confirmation and project number. Collecting data before registration is one of the most common reasons an audit is not recognised.
Step 4: Collect your data safely
Build a simple data collection sheet: one row per patient, one column per criterion, and every answer coded as Y (met), N (not met) or NA (not applicable). Under it, write definitions of what counts as "documented" and what to record if a document is missing. Pilot the sheet on three to five cases and tighten any definition that makes you hesitate.
Audit uses confidential patient information, so data protection law (UK GDPR and the Data Protection Act 2018), the Caldicott principles and your trust's information governance policy all apply. In practice:
Use case numbers, not names, NHS numbers, hospital numbers or dates of birth.
If you need to find a record again, keep a separate key on a secure trust system.
Store data only on trust systems, never on your phone, personal laptop, personal email or messaging apps.
Do not include details in slides or posters that could identify a patient, such as a rare diagnosis with a date.
Asking a colleague to independently check a sample of your cases is a simple way to show your data is reliable.
Step 5: Calculate, present and agree actions
The maths is simple. For each criterion:
Compliance = number met ÷ number applicable × 100
"Applicable" means met plus not met, so leave out NA cases. If a criterion applies only to the 22 patients assessed as at risk, divide by 22, not by the whole sample. Always show the numbers behind each percentage, such as "77.5% (31/40)", because with small samples one patient can shift the result noticeably.
Then find out why gaps happened. Talk to the nurses, doctors and pharmacists who do the work, and look for patterns such as night admissions or a form that is hard to find on the electronic system.
Present at your department's audit or clinical governance meeting. A clear structure is: background, standard, method, results (one chart), reasons, proposed actions and re-audit date. Describe results neutrally ("the ward achieved 77.5%") rather than blaming individuals, and invite the team to agree the actions.
Each action should address a cause you found, with a named owner (by role), a deadline and a way to check it happened. System changes, such as adding an item to the admission checklist or moving a form, tend to work better than "raise awareness" or a single email.
Step 6: Re-audit and close the loop
The re-audit is what makes your project a complete audit cycle, and it is what shortlisters most want to see. Once the changes have been in place for a few months, collect the same data in exactly the same way: same criteria, definitions, data sheet and type of sample. Changing the method means you can no longer tell whether a difference is due to your actions.
Report the results honestly. Partial improvement is still a result: "Two of three targets are now met; information-giving improved but remains below target, so we have agreed further actions and a second re-audit." If you will rotate before the re-audit, hand the project over properly to a named colleague with the registration number, data sheet and action plan, and ask them to share the results.
On your application, include the standard, your role, the numbers from both cycles and the change you made. Vague audit descriptions are a common weakness, as we explain in why NHS job applications get rejected.
Our free Clinical Audit and Quality Improvement: A Step-by-Step Guide course follows a full worked audit through every one of these steps, with a sample data sheet, calculations and a re-audit, alongside a complete quality improvement project.
Start the free course
Clinical Audit and Quality Improvement: A Step-by-Step Guide is split into short modules covering the audit cycle, quality improvement with PDSA cycles and run charts, doing a valid project in your home country, and writing it up for your CV, application and interview. It is free to study, includes a quiz, and offers an optional verifiable certificate and a reflective note for your appraisal. Start the audit and QIP course.
If you would like your NHS application reviewed and rewritten (£35), email cvreviewexperts@gmail.com.
Frequently asked questions
Does a clinical audit need ethics approval?
Clinical audit does not usually require review by a research ethics committee, according to the Health Research Authority's guidance on defining research. You still need to register it with your trust's clinical audit team and follow information governance rules.
How many patients do I need for a clinical audit?
There is no fixed number, but 20 to 50 consecutive cases is often enough for a local audit to show a pattern. On a small unit, you can include all eligible patients over a set period instead.
How long does a first clinical audit take?
A first cycle can often be planned, registered, collected and presented within one to two months on a normal rota. The re-audit usually follows a few months after the changes are in place.
Is an audit without a re-audit still worth putting on my application?
Yes, as long as you describe it honestly as a first cycle with a planned or handed-over re-audit. A completed cycle with re-audit is stronger evidence, so aim to close the loop where you can.
Can I do a clinical audit in my home country before coming to the UK?
Yes. Use your country's national guidelines or your hospital's written policy as the standard, get approval from your head of department or quality committee, and keep patient data anonymous. Describe it on your application in the same way as a UK audit.
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