Audit in British hospitals

For many reasons acute hospitals appear to be the ideal places to evaluate and develop medical audit in Britain. This is despite the fact that they handle a relatively small and selective proportion of the work load in health care compared with long-term care, general practice, and community health. Most of the pioneering work on audit in North America has focused on hospital care, and many of the problems and possible solutions that have emerged may apply elsewhere. Dr John Porterfield of the American Joint Council on Accreditation of Hospitals has said that hospitals offer the most expensive and most critical form of care, provide the necessary clerical and administrative structure for audit, and deal with the tangible episodes of illness. In Britain the cogwheel structure of medical advice in hospitals is a more appropriate forum for discussion than is available in many general practices. There are at least some junior medical staff, and clerical staff experienced in handling data. Medical records are more uniform and comprehensive, and statistical and diagnostic data are available for inpatients through the Hospital Activity Analysis, the Mental Health Enquiry, and the Hospital In-Patient Enquiry. The purpose and nature of inpatient treatment are easier to define than in other areas of health care, there are fewer patient contacts, and there is more time to examine patients and record information. These advantages reinforce, and are in turn reinforced by, a long teaching tradition.