Clinical audit and organizational audit in palliative care.

Palliative medicine has a history of critical appraisal dating back to the start of the hospice movement during the 1970s. Methods and audit tools are available and have been tested, especially for clinical audit. Practical approaches such as the Support Team Assessment Schedule, the Edmonton Symptom Assessment System and topic audits are particularly recommended. Developments in clinical audit could lead to clinical algorithms or protocols to assist patient management. Organizational audit is less well developed, and the scientific basis of choosing the standards is questioned. However, only with the piloting of organizational audits will their true value emerge. There are, however, constraints of time and resources: audit should be cost effective and in the future will need management and evaluation.