Audit of resuscitation decisions has little impact on clinical practice

To determine if clinical audit leads to sustained improvement in resuscitation decision-making.

Analysis of data from five studies performed over nine years between 1989 and 1998. Two of the surveys included all medical and elderly patients, while three surveys in 1993, 1994 and 1996 included only patients over 75 years of age.

The three surveys involving only elderly patients revealed significant improvement in recording the decisions made on resuscitation (73% vs 50%; p = 0.02) over a two-month audit cycle, but this improvement was not maintained. Clinical audit and the use of a proforma improved neither the practice of discussing resuscitation with patients nor the involvement of consultants in the decision-making process over the nine-year period.

Clinical audit may lead to short-term improvements in resuscitation decision-making, but this improvement does not appear to be sustained over time. Other measures need to be considered to improve practice in this area.