The purpose of internal audits in litigation

Internal audits are a cornerstone of accreditation readiness, but in litigation, they serve a different purpose: demonstrating whether an organization actively identified and addressed risk before harm occurred.

Hospitals often conduct audits of handoff communication, documentation practices, and escalation protocols. However, the value of those audits depends on how well they are documented and whether they lead to meaningful action. A completed audit alone does not establish defensibility. What matters is whether findings were tracked, addressed, and resolved in a timely and measurable way.

Attorneys frequently examine audit records to determine whether the organization was aware of communication breakdowns and what it did in response. When audit findings are vague, lack follow-up, or are disconnected from corrective actions, they can reinforce a narrative of inaction. In contrast, detailed records tied to specific interventions, such as targeted training, workflow changes, or updated protocols, can demonstrate a pattern of accountability.

Tracer methodology and multidisciplinary reviews can further strengthen this position by showing how systems function across departments and shifts. These approaches provide a more complete picture of whether communication failures are isolated or part of a broader pattern.

Mark S. Davis, founding partner of the Davis Levin Livingston law firm, says the strongest audit records are those that clearly connect findings to action.

“You need documentation showing any efforts that were ongoing in the moment, such as records showing what was evaluated, who conducted the review, and what metrics or standards were applied,” he says. “Then, you will need corrective-action records tied directly to audit findings, showing that identified gaps led to concrete interventions. When you can show records that reveal a pattern of continuous monitoring/accountability with time-stamped records, it will demonstrate consistent attention to communication standards, making a strong case that the hospital actively manages risk rather than simply reacting after the fact.”

Editor’s note: This article was excerpted from our Inside Accreditation & Quality newsletter.