Possible criteria for audit of urinary tract infection care 1 The accuracy of the diagnosis-that is, was an appropriately taken midstream urine specimen used to make the diagnosis, and was the result consistent with the diagnosis? 2 Was the infection appropriately investigated and followed up? 3 Was a suitable antibiotic used?Structure-We may want to look at how good our children's facilities are. The best judges of that are the children and their parents, so it is best to find out how we are doing from a patient satisfaction survey. If worded properly, such a survey could use the parents' comments to create ideas to change the existing arrangements to be more "child friendly." Process-We could choose an important topic such as urinary tract infection in childhood. The sort of criteria of concern might be those shown opposite.All these criteria need to be fully discussed, justified by good published work, and then have standards applied to them. For example, the standard for taking a midstream urine specimen before treating a child with a suspected urinary tract infection would probably be agreed by most reasonable general practitioners to be 1 00%.Outcome-This is the most difficult subject to assess in the small populations that we deal with in general practice. However, it is possible to find a few examples. One could be to look at emergency admissions of children with asthma as a criterion of control outcome. Having sampled a group, the number of emergency admissions in a year can be measured. Having created whatever change was in mind for the children's care, the audit can be run again to see if emergency admissions have reduced.Audit is particularly useful in primary care for assessing the effectiveness of clinics. For example, auditing various aspects of asthma care before and after instituting an asthma clinic will help ascertain whether or not the clinic is worthwhile.L Peter is a general practitioner, Harrow, Middlesex.
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