Download MBBS (Bachelor of Medicine, Bachelor of Surgery) General Surgery PPT 14 Surgical Audit Lecture Notes
Surgical Audit
Objectives
? Describe the principle of process and outcome audit.
? Use audit to the benefit of your patients.
? Develop soundly based audit projects.
? Introduction to the basics of surgical research.
Introduction
? We are continuously being scrutinized.
? Living in the era of evidence based medicine and accountability.
? Must show that our standard of practice is satisfactory.
? Research and audit are processes by which evidence is developed.
? Audit generates information related to performance- both individual
and collective.
Case 1
? You have discovered that over
? Key issues
the last year there has been a 2
? Patient scoring systems.
fold increase in the mortality of
patients operated in your unit.
? Case mix alterations process and
outcome audit
? Structure.
Case 2
? A hospital is 2500 bedded hospital
? Average hospital admission is 2500/day
? Cost of one i/v fluid is Rs 200
? Cost of one inappropriate i/v fluid is 200X2500=500,000/day
? Cost of one inappropriate i/v fluid in a month is
200X2500X30=15,00,000/day!!!
Types
vMedical audit :
An audit undertaken by doctors and consists of a review of clinical
events.
vClinical audit :
A review of all potential medical events surrounding the treatment of
a patient. This will include nursing, physiotherapy, social aspects, etc.
Surgical Audit ? What is it?
? To examine whether what you think is happening really , and whether
current performance meets existing standards
? Quality improvement process
? Aspects of the structure, process and outcome of care are selected
and systematically evaluated against explicit criteria.
? Changes are implemented at an individual, team, or service level
? Monitoring is used to confirm improvement in health care
Surgical Audit ? Why do it?
? As a result of local clinical interests
? As a result of clinical incident reporting
? To comply with regional or national initiatives
? To inform patients about surgical results
? To drive continuous quality improvement
? For health care regulation
Components
? Structure :
The physical environment in which healthcare is provided.
? Process :
The activity of providing care.
? Output :
The outcome of that care for both the individual and for the
community as a whole.
3 Elements
? Measurement-Measuring a specific element of clinical practice
? Comparison-Comparing results with the recognised standard
? Evaluation -Reflecting the outcome of audit and where indicated,
changing practice accordingly.
The aims of audit are:
? 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.
Advantages
? Identifies bad practice
? Reduces unnecessary investigations, treatments and procedures
? Decreases hospital stay
? Allows continuous refinement of patient care
? Allows objective assessment of quality of care
? Improves efficiency
? Improves education, training and feedback
Forms of Audit
? Total Practice or Workload Audit: covers all the surgical operations
performed.
? Selected Audit from Surgical Practice: covers all patients who
undergo a selected procedure.
? A Clinical Unit Audit: conducted by a clinical unit in which individual
surgeons may participate.
? Group or Specialty Audit: an audit conducted by or under the
auspices of a group or Specialty Society.
? A Focused Audit: : e.g. what is the wound infection rate after large
bowel surgery.
Audit parameters
? Time utilisation
? Cost effectiveness
? Mortality/morbidity assessment
? Quality of diagnostic services
? Monitoring of performance
? Assessment of newer technology
? Surgical outcome
? Patient satisfaction
The Surgical Audit Cycle
? Surgical audit activities are based on a five-step cycle:
Make
changes and
Determine
monitor
scope
progress
Interpret
Select
results with
standards
peer review
Collect data
? Step 1 Determine scope:
? A thoughtful decision about which area(s) of surgical practice to review.
? Step 2 Select standards:
? A clear description of what is good practice in this area against which the results of the
audit wil be compared.
? Step 3 Col ect data:
? The collection of relevant data.
? Step 4 Present and interpret results with peer review:
? Comparison of results to standards , discussion with peers, decision about what changes
may lead to improvement e.g. learning new skil s, changes in practice, systems etc.
? Step 5 Make changes and monitor progress:
? Alteration of practice in accord with the results and then checking that improvement has
occurred.
Common topics for audit?
Any guessess
Common topics for audit:
? 30 day mortality and significant morbidity;
? length of hospital stay;
? unplanned readmission or re-operation rates;
? positive and negative outcomes;
? operation-specific complications;
? process of care, such as pre-operative care;
? time on waiting list;
? numbers waiting for outpatient appointment;
? use of investigations;
? justification of management; and
? patient satisfaction.
How to select standards?
? evidence-based research and guidelines;
? existing local guidelines;
? look to your specialty group to define standards.
Col ect Data
? what data you wil collect, and how you wil collect it.
? The most important principle here is to ensure that you collect quality data.
? Consider the following questions to help decide on the best quality assessment method:
? What information is necessary to answer the audit question(s)?
? From whom wil it be collected?
? Should it be collected prospectively or retrospectively?
? How wil it be collected?
? During or after the operation, on a PDA, on a computer, on a form, or by questionnaire,
and by whom?
? How wil follow up data be collected?
? By record review, by patient follow-up questionnaire, through the GP, by phone cal , or
by review of routine data, and by whom?
? How will the cases for review in a prospective audit be identified or
selected?
? All patients, random selection, consecutive operations, all patients on
the same day each week, or checklist to determine eligibility?
? How will the cases in a retrospective audit be identified or selected?
? From a register, medical records data, review of referrals, or from
previous appointment schedules?
Present and Interpret Results with Peer
Review
? The results of your audit should be presented at a clinical meeting.
? Peer review is a learning exercise. It is not an opportunity to blame or
brag.
? Involves an evaluation of one's work by one's peers.
? Peers are other surgeons with comparable training and experience.
Make Changes and Monitor Progress
? The next step is to implement any changes that are recommended.
? Implementation involves not just making changes but ensuring that
everyone involved is educated/ informed as to what changes are
being made and why.
? The impact/ effects of the changes made then needs follow up action.
What Makes for Effective Audit?
? Promotion of a culture of audit
? Allocate time and resources
? Oversee and verify data collection
? Productive peer review
What Opportunities Arise from Surgical
Audit?
? Educational opportunities
? Systemic improvement opportunities
What Resources are Required for Surgical
Audit?
? Manual systems
? Computer systems
? Logbooks
?
Key points
? Clinical audit can be prospective and/or retrospective.
? Audit information can be obtained from national, hospital, and
surgeon-specific data.
? Clinical department benefits from a clear audit plan.
? Clinical audit improves patient outcome.
Surgical research
This post was last modified on 07 April 2022