Maximising learning and impact through the secondary use of clinical audit data: examples from the Irish Hip Fracture Database

Clinical audit data are often used only to measure performance, limiting their wider value. Using the Irish Hip Fracture Database as an example, this study shows how audit data can support research, education, service improvement, and policy development, creating broader and adaptable benefits for healthcare systems and informing future audit programmes. Clinical audit is central to quality improvement (QI), assessing care against standards to identify gaps and best practice. However, the broader potential of audit data is frequently underutilised. This study examines how secondary use of clinical audit data, using the Irish Hip Fracture Database (IHFD) as an exemplar, can enhance research, decision-making and broader impact across education, public health, service development, and policy. A deductive analytical approach was applied, whereby identified examples of secondary data use were mapped to the five domains of the Joanna Briggs Institute (JBI) Evidence-Based Healthcare (EBHC) model as the conceptual framework. Analysis included twelve national IHFD reports, published literature, organisational survey outputs (2016, 2020, 2024) and stakeholder-informed documents using aggregated non-identifiable information. Data was extracted by two researchers and mapped to the JBI EBHC model domains. A structured descriptive analysis was reported, in line with the Standards for Quality Improvement Reporting Excellence in Education (SQUIRE-EDU). Secondary applications of IHFD data were identified across all domains of the JBI EBHC model, demonstrating impact at global, national, and local levels. Internationally, the IHFD supported collaboration, shared datasets and global audit development. Nationally, it informed evidence synthesis, service planning, care models, and policy. Audit data informed QI, education, training, research and guideline development. Dissemination through reports, dashboards, education initiatives, and audit-linked incentives (Best Practice Tariff) supported implementation, driving improvements in care quality, data completeness, system-wide engagement and sustainability. Strategic secondary use of clinical audit data can substantially amplify its impact. The IHFD provides a transferable model that can inform or be adapted to support the development of other national audits, supporting scalability, collaboration, and increased value across healthcare systems.