Aspects of audit. 4: Acceptability of audit.

Whether or not audit is accepted in Britain will be determined principally by how it is controlled, how much it costs, and how effective it is. The objectives of audit have been defined as education, planning, evaluation, research, and anticipatory diplomacy--that is, starting internal audit before external audit is imposed on the medical profession. Published reports suggest that in Britain internal audit would be more effective andless expensive than the complex professional standards review organisation devised by the Federal Government in the United States.     

Aspects of audit. 5: Looking forward to audit.

Whatever the misgivings of individual doctors, the formal support being given by professional bodies suggests that medical audit will become established in Britain. It is therefore appropriate to heed the advice of pioneers in the field in choosing methods and topics for audit. Practical problems can be anticipated because of the inadequacy of medical records, retrieval systems, and comparable information on practice patterns and evaluation of traditional processes of patient care. The criterion system of audit may provide a common standard for effective review. This can be used for any group of patients with some characteristic in common. It requires good records and a good records staff. Whatever method is adopted, central support should come from the royal colleges, with community physicians and clinical tutors assisting clinicians at the local level.     

Guidelines for medical audit: seven principles.

The government, general managers, and professional bodies all agree that medical audit should be implemented throughout the United Kingdom. Nevertheless, it is not yet decided either nationally or locally how audit should be defined and what its implications will be. In an analysis to find ways of measuring the design and effectiveness of hospital audit, therefore, seven main measures emerged that might serve as practical criteria. These were the definition of medical and managerial responsibilities; medical organisation; scope of audit; essential characteristics; resources needed; record keeping; and evaluation. Though generally consistent with the proposals of the government and the Department of Health, these seven principles offer some alternative approaches.     

The ultimate audit.

The necropsy diagnoses in 78 stillborn and young infants have been compared with the clinical diagnoses in an attempt to justify post-morten examination in this age group. Clinical diagnosis was confirmed in over 88% of cases but unexpected changes in diagnosis were made in six cases, which indicates that selection is of no value.