Audit vs QIP vs Service Evaluation: What's the Difference and Which Do You Need?

One of the most common questions from trainees preparing for ARCP is: "Does my project count as an audit, a QIP, or a service evaluation?"

The confusion is understandable — the terms are used interchangeably in some trusts, and the differences aren't always clearly taught. But the distinction matters. Getting it wrong means your project might not satisfy the specific requirement you're trying to meet.

The Three Types at a Glance

Feature	Clinical Audit	QIP	Service Evaluation
Core question	Are we meeting the standard?	How do we improve?	What is this service doing?
Requires a standard	Yes — NICE guideline or protocol	No — goal-driven	No
Involves intervention	No — measures existing practice	Yes — tests change	No
Needs ethics approval	Usually not	Usually not	Usually not
Counts for ARCP as audit	✅ Yes	✅ Yes (as QIP)	⚠️ Sometimes — check your curriculum

Clinical Audit: Measuring Against a Standard

A clinical audit measures whether current practice meets a defined, evidence-based standard. The standard must exist before you start — you're not setting it, you're measuring against it.

Classic example: Auditing whether patients admitted with a COPD exacerbation received arterial blood gas measurement within 1 hour, as recommended by NICE guideline NG115.

The audit cycle involves: defining the standard → collecting data → analysing compliance → implementing changes → re-auditing.

Audits are the most commonly required project type for ARCP across almost all specialties.

Quality Improvement Project (QIP): Testing a Change

A QIP starts from a different premise: "We know there's a problem — how do we fix it?"

Rather than measuring compliance with a standard, a QIP designs, implements, and tests a specific change using a structured methodology — most commonly PDSA cycles (Plan-Do-Study-Act).

Classic example: Implementing a new discharge checklist to reduce readmission rates, with iterative PDSA cycles to test and refine the intervention.

QIPs are increasingly valued at ARCP because they demonstrate initiative, change management skills, and understanding of improvement science — not just data collection.

Service Evaluation: Describing What a Service Does

A service evaluation answers the question: "What is this service currently providing?" It describes current practice without measuring against a standard or testing a change.

Classic example: Surveying patients to understand their experience of a new same-day emergency care pathway.

Service evaluations are useful for service development and commissioning, but they may not satisfy the audit requirement at ARCP in many curricula. Always check your specific curriculum before submitting one as an audit equivalent.

How to Tell the Difference Quickly

Ask yourself three questions:

Is there a pre-existing standard I'm measuring against? If yes → likely an audit.
Am I designing and testing a change to see if it works? If yes → likely a QIP.
Am I just describing what's happening without measuring against a standard or testing a change? If yes → likely a service evaluation.

Which One Should You Do?

For most trainees, the practical answer depends on three factors:

What your curriculum requires — check your specialty's ARCP requirements explicitly
What opportunities exist in your department — some departments have active QI programmes; others are better suited to audit
How much time you have — a QIP with multiple PDSA cycles takes longer than a focused audit

General advice: If your curriculum requires one audit and one QIP, do your audit first. It's more structured, has a clearer framework, and is easier to complete within a single rotation. Use the QIP requirement for a project you genuinely want to see improve something.