AUDITING ELECTROCONVULSIVE-THERAPY - THE 3RD CYCLE

Background This is the third large-scale audit in the past 20 years an d compares the practice of electroconvulsive therapy (ECT) in England and Wales with the standards derived from the Royal College of Psychia trists' 2nd ECT handbook. Method Facilities, equipment, practice, pers onnel and training were systematically evaluated during visits to all ECT clinics in the former North East Thames and East Anglia regions an d Wales. Ail other English ECT clinics were surveyed with a postal que stionnaire. Information was obtained for 184 (84%) of the 220 ECT clin ics identified. Results Although some aspects of ECT administration ha d improved since the last audit in 1991, overall only one-third of cli nics were rated as meeting College standards. Only 16% of responsible consultants attended their ECT clinic weekly and only 6% had sessional time for ECT duties. Fifty-nine per cent of ail clinics had machines of the type recommended by the College and 7% were still using machine s considered outdated in 1989. Only about one-third of clinics had cle ar policies to help guide junior doctors to administer ECT effectively . Conclusions Twenty years of activity by the Royal College of Psychia trists and three large-scale audits have been associated with only mod est improvement in local practice.