Clinical Audit - History

History

One of first ever clinical audits was undertaken by Florence Nightingale during the Crimean War of 1853-1855. On arrival at the medical barracks hospital in Scutari in 1854, Florence was appalled by the unsanitary conditions and high mortality rates among injured or ill soldiers. She and her team of 38 nurses applied strict sanitary routines and standards of hygiene to the hospital and equipment, and with Florence's gift with mathematics and statistics, kept meticulous records of the mortality rates among the hospital patients. Following this change the mortality rates fell from 40% to 2%, and were instrumental in overcoming the resistance of the British doctors and officers to Florence's procedures. Her methodical approach, as well as the emphasis on uniformity and comparability of the results of health care, is recognised as one of the earliest programs of outcomes management.

Another famous figure who advocated clinical audit was Ernest Codman (1869–1940). Codman became known as the first true medical auditor following his work in 1912 on monitoring surgical outcomes. Codman's "end result idea" was to follow every patient's case history after surgery to identify individual surgeon's errors on specific patients. Although his work is often neglected in the history of health care assessment, Codman's work anticipated contemporary approaches to quality monitoring and assurance, establishing accountability, and allocating and managing resources efficiently.

Whilst Codman's 'clinical' approach is in contrast with Nightingale's more 'epidemiological' audits, these two methods serve to highlight the different methodologies that can be used in the process of improvement to patient outcome.