Clinical Audits

National Office of Clinical Audit (NOCA)

The National Office of Clinical Audit (NOCA) was established in 2012 to create sustainable clinical audit programmes at a national level. NOCA enables those who manage and deliver healthcare to improve the quality of care through national clinical audit. The NPEC aligns its audit governance structures to the NOCA audit governance standards for audit governance committees, the monitoring and escalation of outliers and for national reporting. 

Further information on the NOCA can be obtained at:

Identification of Hospitals in NPEC Audit Reports

Transparency in clinical audit is recognised as a key factor which builds trust in healthcare systems and trust is critical for system learning and improvement1. In a Cochrane review, it was suggested that the public release of performance data in healthcare may slightly improve outcomes for patients whilst concomitantly leading to little or no difference in the services that patients choose to access2. The identification of individual hospitals in national clinical audit has also been advocated by the National Office of Clinical Audit (NOCA).
Following engagement with maternity hospitals/units and discussion with NPEC Governance Committee members, the NPEC Severe Maternal Morbidity in Ireland Annual Report and the NPEC Perinatal Mortality in Ireland Annual Report will identify hospitals.

When clinical outcomes from a hospital deviates from the expected national norm. (statistical outlier).

The NPEC aligns to the National Office of Clinical Audit (NOCA) standards for audit governance committees, monitoring and escalation of outliers and national reporting.

The monitoring and escalation policy set out by NOCA defines: an outlier is a result that is statistically significantly further from the expected value of an agreed quality indicator than would occur by chance alone. The definition of an outlier therefore is based on setting an expected value for an indicator and defining what level of variation / acceptable limits from the expected value is acceptable, based on statistical probability and / or clinical judgement. An outlier does not in the first instance indicate a problem with the quality of care, but it should trigger further analysis and review in the hospital. In accordance with the NOCA escalation policy the NPEC has to date, communicated with individual hospitals, effectively closing the ‘audit loop’. For further information please click here.

The NPEC are grateful for the continued collaboration and support from the maternity services and are happy to clarify any queries or questions please contact us at for further information.


1. National Advisory Group on the Safety of Patients in England (Chair: Don Berwick), (2013) A promise to learn – a commitment to act, Improving the Safety of Patients in England. Available at: {Accessed on:24/09/2018].

2. Metcalfe D, Rios Diaz AJ, Olufajo OA, Massa M, Ketelaar NABM, Flottorp SA., Perry DC. Impact of public release of performance data on the behaviour of healthcare consumers and providers. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD004538. DOI: 10.1002/14651858.CD004538.pub3


National Perinatal Epidemiology Centre

Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Wilton, Cork