Real time patient safety audits undertaken by Ursprung et al¹ are potentially a novel approach to quality in health care and an interesting application of safety adapted from industry. From an error detection perspective they offer similar advantages to other prospective studies which had greater detection accuracy than retrospective medical record reviews.² The advantage of detecting errors before they occur, as opposed to mandatory or voluntary reporting which has delayed patient and time consequences, is perhaps the greatest strength of real time audits.¹ Real time audits should be able to assist in the development of systems with buffers and redundancy to decrease the likelihood of errors.^1,3

Although the pilot program appears to have worked successfully, the longer term ambitions of the researchers to “develop a streamlined random safety audit tool for use by front line clinical staff without the need for additional personnel” needs to be considered with caution.¹

The authors have made reference to the adoption of this technique from industry; however, what must be considered is that the success of industry has related to continued top up commitment including senior level leadership, dedicated personnel, and financial resources.⁴ Real time problem solving has worked in industry because safety is a core value which is entrenched in the culture.⁴ In order for health care to replicate similar culture changes, support and resources are needed. Limiting the resources available for the audits is likely to result in reduced success. Intercollaboration is needed to develop system changes, and the empowerment of individuals to feel they have resources to change and solve problems is essential in creating safety systems in healthcare organizations.⁴ These areas are likely to suffer if inadequate support and resources are given.

Finally, common disadvantages of criteria audits that can also be applied to this study are the focus on process issues and lack of attention to interpersonal care.⁵ Patient satisfaction is considered critical in measuring quality and ought to be considered alongside safety audits.⁶