Findings from 93 publications were reviewed which ranged from single case studies of individual audit projects through retrospective reviews of departmental programmes to studies of interface projects between primary and secondary care. A full bibliography is available from the authors.
Patient care and service delivery: Patient-centred benefits of audit include improvements in patient care, improved patient satisfaction, and better patient feedback.
Health professionals' attitudes, benefits of audit: benefits to clinicians of audit include improved communication between professional groups and increased professional satisfaction and knowledge, and can be a powerful impetus to changing behaviour.
Health professionals' attitudes, disadvantages of audit: perceived disadvantages of audit are diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation.
Barriers to successful audit: perceived barriers to implementing audit are lack of resources, lack of expertise or advice in project design and analysis, relationships between groups and group members, lack of an overall plan for audit, and organisational impediments.
Promoting successful audit: several studies have shown that audit itself should be monitored with the intention of improving the effectiveness of the audit programme. Factors which facilitate successful audit include the need for practical mechanisms to make data collection easier, including modern medical record systems; information technology and improved links between routine data collection and audit as well as dedicated staff; and protected time to release the burden on clinicians' clinical workload. Key factors which promote successful audit include a supportive organisational environment, sound leadership and direction of audit programmes, strategy and planning in audit programmes, resources and support for audit programmes, monitoring and reporting of audit activity, commitment and participation, and high levels of audit activity seen by its participants to be involving and relevant.