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Time to audit audit

BMJ 1996; 312 doi: (Published 13 January 1996) Cite this as: BMJ 1996;312:128
  1. David Sellu

    Aprime reason for including audit in the recent NHS reforms was the immense variation of clinical practice, outcome, resource utilisation, and other measures of performance among hospitals. Britain may take comfort from the fact that despite the numerous indictments of its health service, it is one of the few countries boasting anything approaching uniform health care. But diversities do occur—the management of breast cancer is one example—and audit presented an opportunity to improve the performance of the under-performers.

    Two types of audit, often confused, were implied in the 1990 white paper, Working for Patients. The first, practised for many years, focused on morbidity and mortality in which deaths, complications, problems with admissions, and delays in discharge were discussed. The reforms made this type of audit compulsory for all clinicians—it is meant to happen once a month during the working day. This has resulted in the loss of one session from each clinical team every month, equivalent to closing the hospital for one day every two months to all but emergencies. Adverse events monitoring has its proponents, but one shortcoming is that lack of adverse events does not necessarily mean good practice or satisfactory outcome. Too many events are audited, no clear goals are set, …

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