The hidden cost of clinical audit: A questionnaire study of NHS staff

Objectives: To determine the full cost of clinical audit in one health board area and extrapolate the result to Scotland. Methods: A questionnaire was sent to a representative sample of NHS staff to determine time spent on clinical audit. This was combined with cost data from clinical audit budgets and unit cost data for staff time. Results: Seventy-two percent of staff participated in clinical audit at some point in time. Medical staff were significantly more likely to participate in audit that non medical staff (P<0.0001). Those who participated in clinical audit devoted only a small proportion of time to it. However, due to the high participation rates in clinical audit, this aggregated to a significant amount. In Forth Valley the total cost was estimated to be £1.72m (£1.37m-£2.10m) and in Scotland £36.3m (£29.6m-£44.0m). Staff time accounted for over 80% of the total cost of clinical audit. Conclusions: Clinical audit is widespread within the Scottish NHS and the total cost of staff time devoted to audit is substantial. Research is needed into the value of clinical audit and the potential cost implications of clinical governance need to be explicitly recognised.