WHY DID THE SCOTTISH EXECUTIVE HEALTH DEPARTMENT CARRY OUT AN AUDIT?

The aim of the audit was to produce improvements in the practices of each site where ECT is delivered. It is intended that these improvements be monitored and maintained in the long term by encouraging local ownership of the audit and its results.

Following a postal survey in 1994 of ECT practice, psychiatrists in Scotland obtained a grant from the Scottish Executive to undertake an audit of ECT to find out as much as possible about facilities, staffing, training, usage and effectiveness.

All 35 ECT consultants in Scotland were recruited as local co-ordinators and the Scottish Electroconvulsive Therapy Audit Network (SEAN) was formed.This group met twice a year for the duration of the project encouraging local ownership of the audit and its results. A pilot study was carried out and the audit itself was undertaken in three phases between 1996 and 1999.

To ensure that all areas of practice were examined all members of the ECT clinical teams took part; psychiatrists, anaesthetists and nurses. During the audit all patients who had ECT in Scotland were included, for example in phase two (between August 1997 and April 1998) this involved 794 patients.

The last phase of the survey (August 1998 to July 1999) involved unannounced visits to each ECT site, to view treatment sessions and to check if safe and correct procedures were used. Attention was also paid to the atmosphere in the ECT suite.

Some sites were found to have very high standards from the outset, but where this was not the case, appropriate action was taken. For example, the only site considered unacceptable in phase one, had been closed by phase three.