Discuss Surgical Audit

By Dr Abali
Dept Of Surgery
JUTH

Outline

Introduction
Principles of Surgical Audit
Administrative Organization of Audit
Advantages of Audit
Disadvantages
Surgical audit and the use of computers
Autopsy and clinical audit
Future prospects
Conclusion

Introduction
Definition
The systemic, critical analysis of the quality
of medical care, including the procedure
used for diagnosis and the treatment, the
use of resources and the resulting
outcome and quality of life for the patient

Introduction
Aims of audit
1, Clear patient focus
2, Greater multi professional working
3, Patient care managed across 1, 2, and
continuing care
4. For closer links with education
5. Better integration of effectiveness of
information

Introduction
Historical background
As old as history
Learn through trial and error
Open documentation
John Graunt 1662
William Farr 1854
Ernest Hey 1908 and Ernest Armory Codman 1910
Critical appraisal
Improvements relied on experts
Regular mortality and morbidity meetings (50s and 60s)
Microcomputers 1980
NCEPOD 1986
Formally in the UK 1989

Principles of Surgical Audit

1.
2.
3.
4.
5.
6.
7.

Criteria for successful audit

Honesty
Accurate and standardized forms
Complete medical records
Confidentiality
Educational not punishment
Relevance to common clinical problems
Objectivity by peer assessment

Principles

1.

2.
3.

Types of surgical audit (Donabedian 66)

Audit of structure (tools):
-Personnel ,
-Organization of personnel,
-Equipment
Audit of process (what is done with the tools): Handling
referrals, Diagnostic tests, Drug prescription, Surgical
intervention, Post op care, Discharge policy
Audit of outcome( effectiveness of the tools):
Reduction in symptoms, Freedom from progression of
disease, Improvement of QoL, Return to work,
Readmission rate, Wound dehiscence/Infection rates

Principles
Mechanism of Audit
2 main ways
-Audit cycle
-Critical event analyses

Intervene to
promote
change

Choose topic

Set standards

Update standard

Collect data

Feedback results
Assess
conformity
with the standard

Principles

1.
2.
3.
4.
5.

Critical Event Analysis

Describe the significant event
Why did it occur?
What has been changed?
What has been learned?
Has the change been continued?

Principles
Techniques of Audit
1.
2.
3.
4.
5.
6.
7.

Basic clinical audit

Incident review/ concurrent audit
Clinical record review
Criterion audit (Retrospective)
Adverse occurrence screening
Comparative audit
National studies (CEPOD,SASM)

Administrative Organization of Audit

Training
Resources
Audit coordinator
Quality assurance
Morbidity and Mortality

Advantages of Audit
Roots out bad practice
Reduction in the no of unnecessary
diagnostic tests
Decreased length of stay
Reduction in no of drugs prescribed
Improves outcome
Not a punitive measure
Effective/ efficient allocation of resources

Disadvantages

Waste of time and resources

No rewards for good practice
Inability to enforce/ effect change
Difficult to quantify some aspects
Not proven to be better than education
May not improve outcome

Surgical Audit and the Use of

Computers
Relevant but not absolutely necessary
Microcomputer database important for
storage
Surgical trainee needs working knowledge
of basic computing
Access could from CD ROM
The Internet is a reference source
Clinical information system software are
available

Autopsy and clinical audit

Relevant in audit
Discrepancy between clinical and autopsy
diagnosis
Provides a good index of quality of patient
care

Future prospects

Palm pilots, pocket PCs

Wireless sharing of information
Anonymised comparative audit
Compulsory training

Conclusion
Every doctor cares more for his
reputation than his efficiency and is
tempted to spend his time in concealing
his ignorance rather than increasing his
knowledge.
E.A. Codman