Objective: To determine if clinical audit leads to sustained improvement in
resuscitation decision-making.
Method: Analysis of data from five studies performed over nine years betwee
n 1989 and 1998. Two of the surveys included all medical and elderly patien
ts, while three surveys in 1993, 1994 and 1996 included only patients over
75 years of age.
Results: The three surveys involving only elderly patients revealed signifi
cant improvement in recording the decisions made on resuscitation (73% vs 5
0%; p = 0.02) over a two-month audit cycle, but this improvement was not ma
intained. Clinical audit and the use of a proforma improved neither the pra
ctice of discussing resuscitation with patients nor the involvement of cons
ultants in the decision-making process over the nine-year period.
Conclusion: Clinical audit may lead to short-term improvements in resuscita
tion 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.