Clinical audit—the systematic assessment and improvement of the quality of care—is now an essential requirement of all clinicians by the government. Clinical audit of the process of myocardial infarction has been performed both in this country and elsewhere for several years,1-3 although the majority of work is performed within individual hospitals rather than in collaboration with colleagues in other hospitals. It has tended to concentrate on the use of thrombolytic treatment. Recent evidence from 15 hospitals examined between 1993 and 1997 showed only patchy improvement in delays from a call for help to treatment. Some hospitals where there were long delays before thrombolytic treatment showed no improvement over that time.4 It was clear from these data that in some hospitals either the incentive or the facilities to improve performance, at least in this area, was lacking.

The National Service Framework for Coronary Heart Disease,5 has been compiled with advice from cardiologists and others involved with the management of coronary heart disease. It requires annual clinical audit of a number of aspects of the management of myocardial infarction. It sets out explicit targets to be achieved in areas such as the delays between a call for help and access to a defibrillator and reperfusion …