Objective. To evaluate the effectiveness of a care pathway for the use of electroconvulsive therapy (ECT) in a UK psychiatric inpatient unit. Methods. A completed clinical audit cycle of the care pathway and variance from it. Results. Sixty courses of treatment were reviewed. All were given for severe depressive disorder. Consent was recorded for all but one course. Clinical assessments were completed for 96% during and 50% after treatment. Conclusions. Use of a care pathway enhanced aspects of the clinical practice of ECT, although the overall effect was inconsistent. ECT was not used to treat schizophrenia. Maintenance ECT continues to be used despite the recent NICE guidance on this subject. The care pathway ensured regular clinical assessment of patients during their courses of ECT.