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Sunday, April 22, 2007

Belling the cat: ECT practice standards

In his commentary in the Journal of ECT Prof. Max Fink pleads for a ECT Accreditation Service (ECTAS) as in the United Kingdom. In the eighties and nineties of the previous century national surveys of actual practice of ECT in the U.K. revealed deficiencies in the practice of ECT. One third of the clinics did not meet the guideline standard, 41% still used outdated equipment. First in Scotland psychiatrists undertook a 3 year cycle of audits to systematically answer questions about patient demographics and outcome. Each ECT clinic was visited twice. In 2003 this initiative was followed in the U.K. Each ECT site was evaluated. Each site evaluation begins with team members completing a 284-item questionnaire assessing facilities, staff and training, consent, anesthesia, treatment and recovery procedures, and precautions and adherence to protocols. A visit by an assessment team (a clinician, a nurse , and an anaesthetist) to observe actual practice follows. Resurveys of evaluated sites are scheduled in a 3 year cycle. An update of ECTAS standards was put on the website in December 2006. An improvement of the quality of ECT in the UK developed. Is this also possible in the US he asks himself, or in The Netherlands I ask myself?

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