The document discusses surgical audit, highlighting its history, aims, and importance in improving surgical care quality through systematic peer review and data analysis. It outlines different forms and types of audit, the audit cycle, and contrasts audit with research, emphasizing the educational aspect of audits to optimize patient outcomes. The document concludes that surgical audits should foster learning from faults to enhance surgical practice.

1. SURGICAL AUDIT
Dr. Karthik K

2. Sub headings
• 1. History
• 2. what is surgical audit
• 3. aims, objective and importance
• 4. different forms and types
• 5. Audit Cycle
• 6. steps in detail
• 7. surgical audit vs Research
• 8. Drawbacks
• 9. conclusion

3. Historical perspective
• References to similar concepts seen in the Edwin Smith
papyrus (2000 BCE) and the Code of Hammurabi (1700 BCE)
• Modern surgical auditing began with Groves (England) in
1908 and Ernest Armory Codman (Boston) in 1912.
• In 1912-American College of Surgeons reported the need
to standardize hospitals and they set five minimum
standards

4. What is surgical Audit
• 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.

5. What is surgical Audit involves:
1.Collection and measurements of clinical activities
and outcome
2.Analysis and comparison using standards,
indicators, parameters
3.Peer review process with feedback mechanism

6. Aims:
1. To identify ways of improving and maintaining the
quality of care
2. To assist in the continuing education of surgeons
3. To help make the most of resources available for the
provision of surgical services.

7. 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
• Improved education, training and feedback
• Reduce legal burden

8. Types and forms of Audit
Types of Audit:
• Retrospective or Concurrent
• Individual, Unit, Hospital, State, Regional, National
Forms of audit:
1. Audit of structures
2. Audit of process
3. Audit of outcomes

9. Audit guidelines and examples:
1.Australian council of healthcare standards (ACHS)
2.POSSUM ( Physiological and operative severity score
for enumeration of mortality ) audit system in UK

10. Audit of Structure
• Concerned with amount and type of resources
available
• No. of hospital beds, staff, nurse to patient ratio,
theatres suites, wards, equipment
• Easy to measure
• Does not necessarily correlate with quality or
effectiveness of care

11. Audit of Process
• Concerned with the amount and type of
processes
• Time utilization, actual operating time, down time
• More relevant than audit of structure
• Identifies problems in surgical practice and its
solutions
• Can be difficult to quantify

12. Audit of Outcome
• Most relevant indicator of quality of care
• 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
• Requires adequate and long-term follow up
• Not always favored by surgeons
• Doesn’t always tell the whole story

13. The Audit Cycle

14. Prerequisites:
• Objectivity
• Honesty
• Accurate and standard forms
• Complete medical records
• Result of investigations
• Post Op Notes
• Follow up
• Autopsy findings

15. Determining Scope
• Should be clearly defined
• Time bound
• Easy to measure
• Relevant to performance and outcome

16. Principles
• Confidentiality, patient privacy
• Relevance to common clinical problems
• Clear standards set by peer assessment
• Education, not punishment
• Audit should lead to appropriate action

17. Audit Parameters
• Time utilization
• Cost effectiveness
• Mortality/morbidity assessment
• Quality of diagnostic services
• Monitoring of performance
• Assessment of newer technologies
• Surgical outcome
• Knowledge of patient satisfaction
• Legal implications of surgery

18. Selection of Standards
• Clear cut standard for what is considered
acceptable clinical practice
• Should be evidence based
• Relevant to local trends
• Relevant to specialty and types of patients seen
• Should define adverse events

19. Data Collection
• Determine source of information
• Identify relevant information
• Assess accuracy of data
• Assess need to modify data
• Determine minimum acceptable quantity of
data

20. Interpretation of Results
• Results should be presented regularly (e.g.
monthly, biannually)
• Results are evaluated by peers (other surgeons/
centers)
• Results should be compared to those of similar
Centers /surgeons
• Quality issues should be identified

21. Appropriate Action
• Recommendations and changes should be made
based on audit findings
• Staff should be educated on reasons behind each
change
• Follow up reaudit
• Audit cycle should be repeated to assess effects
of changes

22. Audit vs Research
Audit
• To inform delivery of the best care
• Measures against known standard
• Usually involves analysis of existing data
or simple questionnaires
• No allocation of patients
• No randomization
• Only used to assess
modalities currently in use
Research
• To produce generalizable new
knowledge
• Tests a hypothesis
• Usually involves collection of new data
e.g. additional Investigations
• test and control groups
• May Involve randomization
• May be used to assess new or
experimental modalities

23. Disadvantages of Audit
• 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

24. 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

25. Conclusion
• 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

26. THANK YOU