SURGICAL AUDIT

Definition- The systematic, critical analysis of the

quality of surgical care that is reviewed by peers
against explicit criteria or recognized standards, and
then used to further inform and improve surgical
practice with the goal of improving the quality of care
of the patients

It is a process by which groups of professionals

agree upon the required levels of excellence in
practice, monitor whether they are being achieved
and then resolve deficits found.

It covers all aspects of surgical care including

procedures used for diagnosis and treatment; the
use of resources and the resulting outcomes and
quality of life for patients.

The purpose is to bring about improvements in

clinical practice and patient outcome.
Aspects of the structure, process and outcome of care
are selected and systematically evaluated against explicit
criteria. Where indicated changes are implemented at an
individual, team, or service level and further monitoring
is used to confirm improvement in healthcare delivery.

Aims
• 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

Clinical audit is recognised as having three elements:

1. Measurement - Measuring a specific element of
clinical practice.
2. Comparison - Comparing results with the recognized
standard (in circumstances where comparison is
possible)
3. Evaluation - Reflecting the outcome of audit and
where indicated, changing practice accordingly.
Advantages of Audit:
- 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
Disadvantages of Audit
• Takes considerable time and effort
• Highlights bad practice.
• Exposes doctors to punitive action
• Pointless if no ability to make changes
• Promotes reliance on protocols and guidelines
above clinical judgment

Types of Audit
• National audits – driven by needs identified in
local and hospital based audits.
• Local/Hospital audits – morbidity and mortality
meets.
Audit Parameters:

• Audit of Structure- Concerned with amount and

type of resources available, for example- No of
hospital beds, staff numbers, nurse to patient ratio,
theatres suites, wards, equipment .
It is Easy to measure and Does not necessarily
correlate with quality or effectiveness of care

• Audit of Process- Concerned with the amount and

type of processes carried out, for example Time
utilization, time to surgery (in specific emergencies),
operating time, down time.
It is More relevant than audit of structure and
Identifies problems in surgical practice and proffers
solutions

• Audit of Outcome- Most relevant indicator of quality

of care, for example Intra and post op mortality,
success rate, morbidity, wound infection rate,
specific complication rates, re-operation
rate, duration of hospital stay, re-admission rate,
cost of care, long term survival, quality of life.
Can be difficult to measure or quantify and Requires
adequate and long-term follow up
AUDIT CYCLE
There are several identifiable stages to complete a
clinical audit:
Stage 1- Identifying the topic for the clinical audit. Pick a
topic one is interested in, where you suspect that
standards could be improved, where the change you
expect to recommend is possible.
Stage 2- Select the relevant audit standards. One may
need to do a literature search for the standards in the
area you have chosen or it may be more easily accessible
through NICE guidelines, department of health guidelines
and speciality associations guidelines etc.
Stage 3- Draft a written protocol. This should include
rational for doing the audit, population to be surveyed,
time frame and data to be measured.
Stage 4- Carry out the data collection. Decide what data
you need to collect. Produce a proforma sheet to gather
the data from individual records.
Stage 5- Compare your data against the selected audit
standard.
Stage 6- Identify the changes that you need to make to
achieve the standard. Put in place any actions and plans
to correct any shortfall between the actual activity and
the selected standard.
Stage 7- Re-audit to complete cycle. Clinical audit is only
of benefit when the audit loop is closed and the services
are improved.
 Audit vs. Research vs. Service evaluation

AUDIT RESEARCH
To inform delivery of the best care To produce generalizable new
knowledge

Measures against a predetermined standard Tests a hypothesis

Usually involves analysis of existing data or by simple Usually involves collection of new data
interview or questionnaires
e.g.. Additional Investigations or treatment
to routine care

No allocation of patients Patients may be allocated to test and control

groups

No randomization May involve randomization

AUDIT SERVICE EVALUATION

To inform delivery of the best care. To define or judge current care.

Answers “does this service reach the predetermined Answers “ what standard does
standard ? ”
this service achieve ? ”

Measures against a standard Measures current service

without reference to a standard
Summary
• 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.