{'fraction_non_alphanumeric': 0.016186340307935254, 'fraction_numerical': 0.006711409395973154, 'mean_word_length': 5.226044226044226, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
National stroke audit.

The national audit of stroke coordinated by the Clinical Effectiveness and Evaluation unit (CEEu) of the Royal College of Physicians of London has now completed three cycles, with the latest results produced this summer1. It is time to evaluate the value and future of such national audits. Considerable resources have been devoted to local audit over the last two decades without many concrete achievements. There are exceptions, but in general local audit tools have not been subjected to rigorous development, samples are too small to answer the questions being asked and the processes required to implement the findings effectively have been absent. National audit can overcome these problems and has the additional advantage of providing individual health providers with benchmarking data enabling them to compare local performance with that of the rest of the country. This combination of robust data with large numbers (statistical power) and meaningful comparisons with one’s peers, has provoked genuine interest from clinicians of all disciplines, from managers and from patient groups. The first two cycles of the audit in 1998 and 1999 showed there were significant areas of stroke care that needed improvement, with very wide variations in the standards of care between different trusts1,2. Between the first two audits major changes took place, with evidence that many hospitals and primary care providers were beginning to seriously address the deficits in their services. This was encouraging and sufficient to persuade the National Service Framework (NSF) for Older People3 to recommend that all hospitals should perform such an audit. In the latest audit, 235 (over 95%) of acute trusts providing care for stroke patients in England, Wales and Northern Ireland took part voluntarily. This is probably the most comprehensive audit of a single clinical condition ever conducted in the UK. Lessons learnt from this audit are applicable to audits conducted for other conditions. However, there is a large question mark over the nature and future of NHS clinical audit activity and the experience of three rounds of data collection perhaps permits us to suggest a few answers. Is the considerable time and effort needed for data collection, often by clinicians who might otherwise be treating patients, justified? Are the methods employed sufficiently robust and the interpretation reliable? Should an audit assess the process of care or outcomes or both? Can the financial resources be justified?