Clinical audit aims to improve the quality of patient care. It identifies, from research evidence, the best treatment for patients, measures current practice and then attempts to improve any deficiencies in order to improve the quality of clinical care. This review will outline the successive steps required to implement the clinical audit, identify the barriers to change, highlight examples of well-conducted acute pain audit and introduce the concept of measuring quality within acute pain services. In addition, the role of clinical audit in national clinical effectiveness strategies will be explored. Recent changes in the law restricting access to patients' confidential data may have a profound bearing on audit, epidemiological research and ultimately clinical governance and the future implications for large-scale investigative audit will be discussed.