A clinical audit template for Notion that closes the loop

See inside the Clinical Audit & QI Studio (PDSA)

The problem it solves

Most audit projects stall after the first audit. You measure a problem, present it, try a change on the ward, and then rotate. Nobody re-audits, so the loop never closes.

The second gap is the PDSA record. Taylor et al. (2014) found that fewer than one in five published PDSA projects reported a sequence of iterative cycles. Without a prediction written before each test, you have a list of things you tried, not PDSA cycles.

The third gap is the run chart. Supervisors ask for one, and a few good weeks are easily over-read as a shift. This studio keeps criteria, counts, cycles and weekly data together and says plainly where each criterion stands.

How it works: Measure → Test → Close

1. Measure

   Write each criterion with its standard, target and exceptions, then enter your audit counts: eligible cases and compliant cases. Compliance % and Met? fill in by themselves. Counts only, never patient-level data.

2. Test

   Try one change at a time as a PDSA cycle. Write the plan and a prediction before you test, then what happened and whether you adopt, adapt or abandon the change.

3. Close

   Re-audit the same criteria the same way. Loop status compares Cycle 1 with Cycle 2 for every criterion and tells you which loops are closed, which improved but missed the target, and which need a new idea.

What the studio checks for you

Every criterion, every PDSA cycle and every run of weekly data carries a plain-language status, worked out by formulas from what you enter. These are the main labels.

Loop status, per criterion

• ⚪ Not yet audited: no Cycle 1 measurement yet.
• ⏳ Re-audit due: Cycle 1 is in, Cycle 2 is not.
• ✅ Loop closed: standard met: Cycle 2 compliance meets the target.
• 🔁 Improved but not met: next PDSA: compliance rose, but not to the target.
• 🔴 No improvement: rethink the change: Cycle 2 is no better than Cycle 1.
• ⚠️ Fix the ⚠️ measurement first: a linked measurement has a problem, such as more compliant cases than eligible ones or two Cycle 1 rows for one criterion.

Documented, per PDSA cycle

• 5/5 ✅: plan, prediction, do, study and the reason for your Act decision are all written.
• 4/5 ⚠️ (or lower): parts are missing, or hold a placeholder such as n/a, tbc or "as above", which does not count. It checks that real text is there, not whether the text is good.

Shift signal and runs check, per criterion

• 🟢 ▲ Shift above median (better): six or more weeks in a row above the baseline median, in the direction you set as better. The 🔴 version flags a shift in the worse direction.
• Runs within expected range: the number of runs sits inside the published limits for your number of useful points (10 to 30).
• Too few or too many runs: labelled 🟢 or 🔴 by direction, or ⚠️ when there is no clear direction or too many runs.

The shift rule and runs limits follow Perla, Provost & Murray (2011). You copy the baseline median once from the table footer, because Notion formulas cannot read other rows. Trends and astronomical points are checked by eye.

The worked example

Fictional study

The worked example is fictional: the Mercy General heart-failure discharge audit in a 200-bed community hospital, with illustrative numbers. It has four criteria, two audit rounds of 40 discharges each, four PDSA cycles and 16 weeks of run-chart data. Teach-back rises from 52.6% to 92.3% and its loop closes; follow-up rises from 55% to 75% against an 80% target, so it shows 🔁. One PDSA cycle is abandoned and one is left at 4/5 on purpose. The run chart shows a shift above a baseline median of 52.25%, with 8 runs in 16 points. Clearing the example takes a few minutes.

Method and sources

The studio follows HQIP's guidance on clinical audit (standard, criteria, measure, change, re-audit), the Model for Improvement and its PDSA cycle (Langley et al., 2009), the evidence on how PDSA is used in practice (Taylor et al., 2014), run-chart rules (Perla, Provost & Murray, 2011) and SQUIRE 2.0 for reporting (Ogrinc et al., 2016). Measure, Test and Close are this studio's shorthand, not formal terms.

A separate page, "Audit, QI or research?", sets out the UK route (the Health Research Authority's categories) and the US route (45 CFR 46.102), and says plainly that your IRB, ethics committee or QI office decides, not the studio.

What the studio does not do

• It does not give clinical advice, and it does not decide whether your project needs ethics review.
• It draws no chart: the run chart is a sorted table and a ▲/▼ sequence. A signal is not proof that your change caused it.
• Loop status compares two audit cycles. A third audit is recorded and checked against its target, but you compare it with the earlier cycles yourself.
• Enter aggregate counts only, never patient-identifiable data, and follow your organisation's audit and information governance rules.

What you get

• A one-page PDF with your private link, sent by Gumroad straight after checkout. Click it, then Duplicate, and the studio is in your own Notion workspace, yours to keep.
• Simple mode: three steps, one small table each, with a plain instruction above every table. You can start in Notion for the first time today.
• Audit loop status, compliance by audit round, PDSA cycles, a run-chart table and rules check, and a decision log.
• Export views that turn your audit summary, measurements, PDSA log and run-chart data into clean CSV tables.
• A Start here page, a method guide with full references, and a worked fictional example you can clear in a few minutes.
• Works on Notion's Free plan. No charts, no paid features and no Notion AI needed.

Related guides and templates

• Correlation vs causation

  why a run-chart shift is a signal, not proof

• Data collection methods

  audit counts, records review and direct observation

• IMRaD structure explained

  the section order SQUIRE 2.0 reports build on

• How to write a data management plan

  keep audit data aggregate and governed

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