A clinician's guide to setting up audit.

potentially missed because of normal auditory brain stem responses. Acoustic reflexes have the advantages of being cheap, easy to perform, and usually immediately available. Despite their poor specificity their routine use would mean that about a third of patients could be reassured at their initial clinic visit and not require further investigation. However, the criteria used by us for normality are much stricter than those usually quoted, and they have not been widely used for this purpose. Further evaluation of sensitivity is necessary in a large group of patients with tumours. This study shows that there are economic and clinical justifications for including tests of auditory brain stem responses and acoustic reflex thresholds in serial protocols for investigating suspected lesions of the cerebellopontine angle. With escalating health care costs many areas of clinical practice justify the close inspection that can generate such conclusions. Clinical audit should always take precedence over financial audit; when there are various options which are equally acceptable clinically, however, economic considerations may show some procedures to be more efficient than others, and these should be preferred. 7 Anonymous. Imaging patients with suspected acoustic neuroma tEditorial]. The audiological evaluation of cerebellopontine angle tumor suspects: a review of tumor and non-tumor suspects. Interpretation of loudness recruitment tests-some new concepts and criteria. By April 1991 the Department of Health expects medical audit to be implemented in every hospital. The implementation of some district audit programmes has already been described.' 2 In Hounslow and Spelthorne the district audit advisory committee was concerned with the need to disseminate an understanding of audit, dispel a fear of the process, and provide sufficient guidance to enable clinicians to implement audit. To that end it produced a guide of its plans and the necessary actions, which was sent to every consultant in the district. (The districts have two general hospitals: Ashford and West Middlesex University Hospitals.) A covering letter requested the consultants to complete a confidential questionnaire designed to help identify current strengths and deficiencies in audit, which is essential in planning how to share expertise and resources throughout the district. Within three weeks completed questionnaires had been received from more than 60% of the recipients. This paper is a synopsis of the circulated document. How to set up audit Intended for guidance rather than as a rulebook, the document had three principal aims. * To review the background and basic principles of clinical …