SURGICAL AUDIT

surgical audit is a process used by clinicians who seek to improve patient care.

The process involves comparing aspects of care(structure, process and outcome) against explicit criteria. keeping track of personal outcome data and contributing to a clinical database ensures that a surgeon's own performance is monitored continuously and can be compared with a national data set to ensure compliance with agreed standards

  If the care falls short of the criteria choosen, some change in the way that care is organised should be proposed . This change may be required at one of many levels. it might be an individual who needs training or an instrument that needs replacing. at times, the change may need to take place at the team levels.

  

         Sometimes, the only appropriate action is change at an institutional level(eg-a new antibiotic policy), regional level (provision of a tertiary referral centre) or indeed, national level (screening programmes and health education campaigns).

     

     Essentially two types of audits may be encountered: national audits( eg- in the UK, the national institute for health and clinical excellence-NICE) and local/hospital audits.

   Both are designed to improve the quality of care.

In an ideal world, national audits should be driven by needs identified in local and hospital based audits that are closest to the patient. For example, hospital topics are often identified at the departmental morbidity and mortality meetings, where issues related to patient care are discussed .

   The reporting process might identify a possible national issue, and a national audit could be designed to be completed by the local audit department and surgical teams.

Audits are formal processes that require a structure . the following steps are essential to establish an audit cycle:-

1.                   Define the audit question in a multidisciplinary teams.

2.                  Identify the body of evidence and current standards.

3.                  Design the audit to measure performance against agreed standard based on strong evidence. Seek appropriate advice(local audit department in UK)

4.                  Measure over an agreed interval.

5.                  Analyse results and compare performance against agreed standards.

6.                  Undertake gap analysis- a) if all standards are reached, reaudit after an agreed interval. b) if there is a need for improvement, identify possible interventions and agree with the involved parties.

Reaudit.