Sequential audits of geriatric care: measuring change in structure and process and the contribution of clinical audit

Sequential audits of care in geriatric practice can demonstrate improvement in its content and quality, and identify its strengths and weaknesses. However, there are problems in such sequential audit, particularly if it depends on data entry by lay staff rather than trained researchers. These include: changes in staff and patients from one audit to the next; having to take into account instances where the desired standards are already in place and therefore no further improvement can be shown, or where initial standards are so low that only improvement can take place.

To demonstrate methods of analysis of sequential audits in long-term care for elderly people and in geriatric day hospital practice designed to overcome these difficulties.

Audit packages for long-term care and for care provided by geriatric day hospitals have been evaluated in each case by analysing two audit cycles carried out at eight and six month intervals respectively.

The Royal College of Physicians CARE scheme for audit of long-term care was carried out in 17 locations (nursing homes and geriatric long-stay wards) in two cycles at an interval of eight months. The Royal College of Physicians audit scheme for geriatric day hospitals was carried out in 27 day hospitals in two cycles at an interval of six months. A different method of analysis and presentation of results was devised for each of the two projects.

The two methods of analysis and presentation of data used to evaluate the effect of sequential audits reveal the ups and downs in the standards of care provided by the different institutions for the care of the elderly, and in the standards of care experienced by individuals resident in the same long-term institutions. Overall, sequential audits show that improvement outweighs deterioration in all domains of geriatric care, and suggest that audit contributes to this improvement.