“ … surgery without audit is like playing

cricket without keeping the score.”

(Hugh Brendon Devlin 1932-

1998, Founding Director of the Surgical
Epidemiology and Audit Unit, Royal College
of Surgeons of England)
Surgical audit is a process used by
surgeons who seek to improve patient
care. The process involves comparing
aspects of care (structure, process &
outcome) against explicit criteria.
 Local/Hospital Audit
 National Audit
 To identify ways of improving and
maintaining the quality of care for
patients
 To assist in the continuing education of
surgeons
 To help make the most of resources
available for the provision of surgical
services.
 Audit of Structure
 Audit of Process
 Audit of Outcome
 Structure – what is in place
The people, their training, their knowledge, the way
they are led, the equipment, their organization, the
way they are paid, etc.

 Process – what you do

How referrals are processed, what diagnostic tests are
done, the antibiotics that are used, the thromboembolic
prevention that is customary, the use of intensive care, the
policy of feeding & mobilization after surgery, the
discharge policy, etc.

 Outcome – the results you get

Wound dehiscence rate, readmission rates, mortality,
freedom from progression, reduction in symptoms,
improvement in quality of life, return to work, etc.
If the care falls short of the criteria chosen, some
change in the way that care is organized is
proposed, it may be required at one of many levels:
 An individual who needs training
 An instrument that needs replacing
 At team level e.g. nurses undertaking procedures
instead of, or in addition to, doctors
 At institutional level e.g. new antibiotic policy
 At regional level e.g. provision of a tertiary
referral centre
 At national level e.g. screening programmes &
health education campaigns
 Identifies bad practice
 Reduces unnecessary investigations,
medications and treatment
 Decreased length of admission
 Allows continuous refinement of treatment
modalities
 Allows objective assessment of quality of
care
 Improves efficiency and guides resource
allocation
 Improved education, training and feedback
 Healthy competition
 Takes considerable time and effort
 Highlights bad practice and “bad
doctors”
 Exposes doctors to punitive action
 Doesn’t always tell the full story
 Pointless if no ability to make changes
 Promotes reliance on protocols and
guidelines above clinical judgment
 Surgical audit is a continuous quality
improvement process which systematically
reviews surgical care against explicit
criteria to guide the implementation of
change
 It is a non- punitive, educational process
aimed at improving the outcome of patients
 Locally relevant criteria should be
compared against appropriate local
standards to guide resource allocation,
surgical practice and decision making
 A good surgeon must never hide his/her
faults, but should learn from them in order
to better serve his patients and improve
his practice