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Three Decades of Quality Improvement in Electroconvulsive Therapy: Exploring the Role of Accreditation

Murphy, Geraldine BSc(Hons); Doncaster, Emily BSc(Hons); Chaplin, Rob MBChB, MRCPsych; Cresswell, Joanne RN; Worrall, Adrian MSc, BSc(Hons), DOccPsych

doi: 10.1097/YCT.0b013e3182926fc4
Original Studies

Objectives This study aims to track electroconvulsive therapy (ECT) clinics’ compliance with standards for the administration of ECT before and after the introduction of the Electroconvulsive Therapy Accreditation Service (ECTAS) in 2003.

Methods Three audits on the practice of ECT were retrospectively analyzed, and ECTAS data from 2004 to 2011 were prospectively analyzed. Overall compliance with 10 ECT audit standards was presented in 2 ways: annually and for each of the 3 waves of accreditation.

Results There have been continuing improvements since the introduction of the accreditation service in compliance with all 10 ECT audit standards whether measured annually or by accreditation cycle, although these improvements have not been linked to changes in clinical outcomes.

Conclusions Although improvements in ECT delivery have coincided with the accreditation service, other factors may have also contributed.

From the Royal College of Psychiatrists’ Centre for Quality Improvement, London, UK.

Received for publication February 20, 2013; accepted March 15, 2013.

Reprints: Adrian Worrall, MSc, BSc(Hons), DOccPsych, Royal College of Psychiatrists’ Centre for Quality Improvement, 21 Mansell St, London, E1 8AA UK (e-mail:

The study was partly funded by contributions from the Electroconvulsive Therapy Accreditation Service (ECTAS) member services to which the authors are very grateful.

The authors work for the Royal College of Psychiatrists and ECTAS.

© 2013 by Lippincott Williams & Wilkins