<P> Clinical audit can be described as a cycle or a spiral, see figure . Within the cycle there are stages that follow the systematic process of: establishing best practice; measuring against criteria; taking action to improve care; and monitoring to sustain improvement . As the process continues, each cycle aspires to a higher level of quality . </P> <P> These processes are related to change management methodology and use the techniques of PDSA cycles, LEAN, Six Sigma, root cause analysis and process mapping . </P> <P> Stage 1: Identify the problem or issue </P> <P> This stage involves the selection of a topic or issue to be audited, and is likely to involve measuring adherence to healthcare processes that have been shown to produce best outcomes for patients . Selection of an audit topic is influenced by factors including: </P>

When did audit and peer review become a term of service requirement