Clinical governance through audit in promoting quality in clinical practice: scoping review

Abstract

Introduction
Clinical auditing is one of the main pillars of clinical governance, crucial for safe healthcare. It is a key tool for continuous improvement in terms of clinical practices and results, making it possible to verify the application of strategies and procedures aimed at increasing patient safety.

Objective
To map the knowledge and identify the effects, through a literature review, of clinical governance through the auditing process in promoting quality in clinical practice.

Methods
Literature review, namely scoping review, according to the methodology of the Joanna Briggs Institute, and PRISMA 2020 Checklist guidelines, registered on the OSF (Open Science Framework) platform. The studies were identified by a search carried out on 31 January 2024 in the PUBMED, EBSCO (MEDLINE Complete, Cochrane Library Plus and CINAHL Plus With Full Text), SCOPUS, Web of Science and RCAAP (Repositório Científico de Acesso Aberto de Portugal) grey literature databases using descriptors and free terms in Portuguese, English, Spanish and French, from 1998 onwards. Two independent reviewers carried out the study's relevance analysis with data extraction and synthesis between March and May 2024.

Results
Initially, seventy articles were obtained, but fourteen were subsequently eliminated because they were duplicates. A total of fifty-six articles were analysed. Thirty-seven articles were excluded for not meeting the inclusion criteria and seven for not having access to the full article. Nineteen articles were analysed in full. In the end, nine articles were included in the review article, with three articles excluded due to eligibility. The effects of clinical governance in promoting quality in clinical practice through the audit process identified were access to quality care, guaranteeing user safety, collective responsibility, as well as accountability. In turn, the main shortcomings identified were the absence of an ingrained culture, lack of training for auditors, along with breaks in the audit cycle.

Conclusion
Clinical auditing is an asset in the clinical governance process, so its systematic practice promotes increased clinical effectiveness, risk management, professional development, as well as transparency in terms of publicising the results obtained, ensuring standards of professional practice and promoting continuous improvement in the quality of services. It plays a crucial role in ensuring adherence to legal regulations and standards, minimising legal and financial risks and promoting clinical management based on responsibility and transparency. This is vital for maintaining the trust of users, as well as the credibility of institutions in the eyes of regulatory bodies and society as a whole, ensuring that healthcare practices are always in line with legal and ethical requirements.