“no treatment regimen was identified as having an improved clinical outcome”


Accreditation relies on auditing for total compliance with SOPs.  Inspection of this assures quality.  Even when it doesn’t.

Drs Williams and Brindle reported another type of audit and showed wide variation for the treatment of an infective condition.

Journal of Infection Volume 73, Issue 3, September 2016, Pages 291–293

Audit of guidelines for antimicrobial management of cellulitis across English NHS hospitals reveals wide variation

“In summary, our audit has highlighted significant variability in the management of cellulitis across the 23 acute NHS Trusts examined. This heterogeneity was identified across the choices of antibiotics recommended, the modes of administration, and the duration of therapy. It has also highlighted the variability of recommendations by individual clinicians based on the perceived severity of the infection. Although the numbers of guidelines examined is relatively small, and geographically restricted, it is likely that such variability is a feature across most acute Trusts in the UK.

“The Cochrane review has identified 43 studies, omprising 5927 patients, with outcome data on patients treated for cellulitis using a bemusing variety of treatment regimens. Overall, no treatment regimen was identified as having an improved clinical outcome when compared with another antibiotic, and no recommendation could be made for any single antimicrobial. As all antimicrobials examined appear to be equally effective it is recommended that a narrow spectrum anti-staphylococcal penicillin (e.g. flucloxacillin) or a macrolide or lincosamide (for those unable to tolerate a beta-lactam) should be used for the treatment of cellulitis.”

We might expect that a similar range of acceptable variation might exist in many other situations where UKAS demands conformity to a single procedure they can inspect.  Just as no treatment regimen was found to have an improved treatment outcome, in many circumstances no single procedure enforced to the purposes of compliance audit will be able to justify itself either.

Uniformity isn’t the only good way.

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