Audit is the process whereby clinical and administrative activities are subjected to rigorous quality control studies periodically or continuously so that standard of care can be improved.

Clinical topics we investigate regularly include:

• survival;
• conservation of the eye;
• preservation of vision;
• complications;
• results from the patient's point of view (ie, 'patient centred outcomes').

Administrative topics we audit include:

• time between receipt of patient referral and first clinic appointment;
• time between first visit and treatment;
• satisfaction of patients;
• satisfaction of referring ophthalmologists.

We have a full time data manager, who ensures that the database is correct and complete. We have introduced a structured questionnaire for routinely eliciting and recording all ocular symptoms of all patients at every follow-up clinic.

We have also developed a system for recording accidents as well as 'near-misses', so that complications can be prevented.

We have recently installed a computer terminal in our operating theatre so that we can computerize all important information, including complications, at the end of each operation.

The audit results are reviewed as soon as they become available.

Appropriate action is taken after discussions are held amongst members of our Centre. For example, when a survey revealed that referring ophthalmologists felt that they had waited too long for our report after the patient's discharge from hospital, discharge letters were written at the end off the operation instead of when the patient was discharged.

The Department of Health has published standards, which must be met by cancer care providers in all specialties and we assess our own results in terms of those standards.

In addition, we provide our funding authority, NSCAG, with our own results upon request so that they can assess our performance. Generally, we seem to be setting our own standards because data on the performance of other ocular oncology centres are not available.

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