Audit

Audit has become an essential part of medical practice. The main purpose is to improve quality of care. In the Critical Care Unit, this should involve all members of the multidisciplinary team. Change in practice in one discipline will inevitably have a knock-on effect in others. Audit may involve a review of activity, performance against pre-determined indicators or cost-effectiveness. Audit may focus on specifi c topics or may encompass the performance of several Critical Care Units. A successful audit requires commitment from senior staff to ensure practice is defined, data are collected, and change is effected where necessary. Where change is suggested by audit, a further review is required to ensure that such change has occurred.

Data collection

Ideally, a basic dataset should be common to all Critical Care Units nationally to allow meaningful comparisons to be made. This requires a dataset detailed enough to answer questions posed, but not so detailed that collection becomes unsustainable. Resources must be provided in terms of computer databases and staff to collect and analyse data. This is a skilled task that should not be delegated to junior team members. The data collector should be familiar with the fundamentals of critical care medicine, and be provided with regular summary reviews to ensure enthusiasm continues and quality control is maintained. Methods of data entry should consider the time involved and that most of those collecting data are not keyboard experts. Typographical mistakes destroy the value of collected data so error trapping and data validation must form part of the housekeeping in any database used. Some audit topics require data collection outside the basic dataset. Collecting appropriate data requires clarity in setting the question to be answered and care in choosing data items that will truly answer the question.

Audit meetings

Regular audit meetings should follow a pre-defi ned timetable. This helps to ensure maximum staff attendance and also sets target dates for data collection and analysis. Audit meetings should be chaired and have defi ned aims. Discussion of the topic being audited must lead to recommended changes in practice and these must be followed through after the meeting. It is clear that all staff cannot attend all meetings. Dissemination of information prior to implementing proposed changes is necessary to stand some chance of carrying them through.