Why clinical research needs medical audit.

Clinical research is considered by many doctors as erudite and not an activity likely to involve them directly. Indeed, most medical practitioners are so distanced from clinical research that they do not consider entering patients into clinical trials. The reasons for this are unclear but may derive from attitudes acquired as undergraduates , when research is often perceived as unrelated to the "real" world of medical practice, but belonging to an elite world set apart from routine practice. On the contrary, if you take the view, as I do, that good clinical research is not only concerned with the innovation and evolution of new clinical interventions and treatments but is also the vehicle for the logical and measured introduction of new treatments and approaches to care into routine practice, then all practitioners have a clear role in the clinical research process. As the basis of clinical research is clinical practice then there is a clear relation between medical audit and clinical research. The final step of a good clinical research programme will be medical audit as this provides a mechanism for ensuring that the results of research have been incorporated into clinical practice. Both research and audit activity need to involve all relevant practitioners at all stages of planning and implementation. The connection between clinical research and audit must be understood and exploited if audit is to make an impact on the quality of care not simply in units or individual hospitals but also at regional and at national level. Good audit is possible only when clinical interventions and innovations are based on good clinical evidence. Getting doctors (or anyone) to change practice is difficult. Clinical research has tended to progress without any clear policy on how practice is ultimately going to be modified. As an academic haematologist with an interest in haematological malignancy it seems clear to me that medical audit is also important for facilitating clinical research as it is through the medical audit process that the quality of clinical care is assessed and compared with an agreed guideline. This connection between clinical research and audit is important; these are linked in series rather than in parallel. It is critical that the audit process feeds the next research ideas and that the evaluated results of well constructed research projects are the focus of the next audit. An example taken from the work of the haematologists in Northern region …