Abstract
This paper summarizes five methods for clinical auditing that are carried out concurrently at the London Psychiatric Hospital. The first type of audit is carried out by the Medical Records Department and consists of a check-off list of items that for accreditation purposes must be included in the record. The second and third types of audit compare the content of the records from samples of similarly diagnosed or treated patients to criteria previously specified by a committee of professionals. The fourth type of audit is really a collection of audits in which each of the clinical departments: Nursing, Social Work, Occupational Therapy, and Psychology, check random samples of files on a monthly basis for the contribution to the record made by their own departmental members. These files are checked against specific questions laid out on a departmental audit form, and feedback is given directly to the departmental member.
The four preceding types of audits all have the advantage of large-scale “screening” of charts. They, however, do not allow for crosschecking recorded data with the condition of the actual patient. The fifth type of audit, the “in-depth single patient care audit” corrects this deficit, and allows for more dialogue with the treatment team. The detailed form that is used for this audit procedure is described in the text. The audit is carried out by a senior clinician from the Department of Medicine in conjunction with a senior member of another discipline. The physician interviews the patient before reading and checking the chart. Both the physician and the senior member of the other clinical department then discuss the charting and the case with the entire treatment team.
This last method of auditing has helped considerably in re-designing a system for charting at London Psychiatric Hospital. The chief drawback of the audit, time consumption, is far outweighed by the advantages that accrue. The procedure affords the unit staff and the auditors opportunities for an ongoing educational experience.