The role of local research ethics committees.

audit works we might expect an improvement when comparing 1990 with the 1987 report. Direct comparison is often difficult and infrequently made by the authors. Necropsy rates have risen from 35% to 47%, although necropsy reports were considered to be poor in 25% of cases and reached the right doctors in only 75%. The proportion of patients examined by a consultant surgeon before operation did not change while consultant participation in the actual operation rose slightly from 47% to 52%. The presence of a consultant anaesthetist rose from 41% to 52%, although in a comparison with control cases a consultant was less likely to be present at emergency operations carrying a high risk of death than at elective, low risk operations. The report concludes that staff should be better matched to the patient's condition. Overall, CEPOD does not seem to have stimulated a radical change in operative practice, but where movement has occurred it has been in the right direction. The report recognises the lack of data on denominators as a serious defect. There were 58 wound dehiscences and 54 anastomotic failures associated with perioperative death-but in how many wounds and anastomoses? How many patients survived these complications? Discussion is often limited, avoiding contentious topics; regional variations are not discussed. Patients and purchasers will obtain no useful information on which to base decisions. Perhaps rightly, the authors are satisfied to present the facts, leaving others to analyse the data rnore critically, quantify avoidability, apportion blame, and identify solutions. For the individual doctors the messages are clear: better audit; clearer documentation; more consultant involvement; increased supervision of juniors, staff grade posts, and locums; and better liaison between surgeons, anaesthetists, and pathologists. Colleges and other professional bodies must now respond to the non-compliance rate of 20%: audit is a fundamental component of professional activity and not an optional extra. The report's plea for more high dependency and intensive care units is directed at management and government, adding further to the demands on their budgets. In the short term clinicians should use these precious and expensive facilities to maximum effect. To maintain the interest and compliance of doctors the next inquiry should further sharpen its focus, giving priority to "unsatisfactory features" that lie within the province of the medical profession rather than those outside it. At a time when many district health authorities and local research ethics committees are probably still digesting the …