The Clarke Institute experience with electroconvulsive therapy: I. Development of a clinical audit procedure

Over the past forty-five years, there has been a progressive refinement of the standards of practice of electroconvulsive therapy (ECT). The need to review contemporary practice patterns to maintain and further improve those standards is discussed. In this context, the respective roles of medical audits and surveys of practice are described and the methodology of recent surveys critically examined. A procedure for the collection of reliable and complete data on the more than 22,000 treatments administered at one psychiatric hospital is described as the essential element of both an accurate survey of practice and a clinical audit. The audit is designed to retrospectively review and prospectively monitor the practice of ECT to identify the areas of conformity with and divergence from current standards of practice. it is recommended that this kind of audit procedure be an integral part of the present day administration of ECT. It is also suggested as a paradigm for hospital practice auditing with potential application to other specific treatments.