Audit in the accident and emergency department.

Audit is all about improving patient care. Most clinicians are now familiar with the fundamentals of the audit loop, and the question "what do you understand by clinical audit?" can be relied on to appear in specialist registrar and consultant interviews. At its most simple the auditing process involves a critical appraisal of present performance, followed by a process of standard setting. Present performance is then compared against the agreed standards and any need for change is identified. Following a change in practice the audit is then repeated to demonstrate any improvement in patient care, thereby closing the loop. Ideally further auditing and standard setting will lead to an incremental improvement in the quality of care of patients. Despite the simplicity of the concepts involved, many audits fail to bring about improvements; worse still the process can appear to be a somewhat tedious and demoralising task to those involved. In this article I shall highlight some of the common pitfalls in the performance of audit and outline those problems which appear to be unique to accident and emergency (A&E) departments.