Deborah Tomalin and Mark Renshaw raise a number of interesting issues in 'Count the cost', not least the need to ensure that clinical audit is effective and cost-effective. This article has prompted us to consider a similar study in Stobhill. We were surprised, however, that they sought to base cost estimates on clinical audit facilitators' time.

In our experience, the time spent by clinical audit staff is only part of the picture. In our annual review of clinical audit projects at Stobhill Hospital, a large district general hospital in north Glasgow, clinical audit staff were only actively involved in 64 of 190 projects during 1998- 99. We have sought wide involvement in clinical audit throughout the hospital, with all clinical departments now involved, and to involve staff from all disciplines. By concentrating solely on the clinical audit input, the actual resource implication and cost to the NHS of clinical audit is excluded from the analysis.

Paula Doig

Clinical effectiveness facilitator

Kerry McKenzie

Clinical audit assistant

Stobhill trust