lecture prepared based on Hamilton & Bailey's chapter on surgical audit for mbbs students

1. Surgical Audit
D R . A H M A D U Z A I R Q U R E S H I
A S S I S T A N T P R O F E S S O R O F S U R G E R Y
K I N G E D W A R D M E D I C A L U N I V E R S I T Y , L A H O R E
F C P S , M R C S , M C P S , P G D I P M E D E D U C A T I O N ( C A R D I F F , P H D S C H O L A R

2. Surgical audit is the systematic, critical analysis of the quality of
surgical care
reviewed by peers against explicit criteria,
used to further inform and improve surgical practice
with the ultimate goal of improving the quality of care
for patients.

7. Audit’s purpose
whether what you think happening
really is !!!!!

8. Audit’s purpose
Whether current performance
meets existing standards !!!!!

9. A surgical audit involves:
Collection of clinical activities
and measurement of outcomes;
Analysis and comparison using
Standards,
Performance indicators and
Outcome parameters
A peer review process with a feedback mechanism to redress
problems.

10. Aims
To identify ways of improving and maintaining the quality of care
To assist in the continuing education of surgeons
To help make the most of resources available for health services

11. One
extra
Drip

12. Example
Mayo hospital is a 2500 bedded hospital
Average in hospital admission is = 2500
Cost of One I/V fluid = PKR 74 + PKR 110 + PKR 10 + PKR 1 = PKR 200 ( APPROX)

13. Example
Mayo hospital is a 2500 bedded hospital
Average in hospital admission is = 2500
Cost of One I/V fluid = PKR 74 + PKR 110 + PKR 10 + PKR 1 = PKR 200 ( APPROX)
Cost of one inappropriate fluid = 200 x 2500 = PKR 5,00,000/day

14. Example
Mayo hospital is a 2500 bedded hospital
Average in hospital admission is = 2500
Cost of One I/V fluid = PKR 74 + PKR 110 + PKR 10 + PKR 1 = PKR 200 ( APPROX)
Cost of one inappropriate fluid = 200 x 2500 = PKR 500000/ DAY
There are thirty days in a month = 200 x 2500 x 30 = PKR 15,000,000 month

15. Example
Mayo hospital is a 2500 bedded hospital
Average in hospital admission is = 2500
Cost of One I/V fluid = PKR 74 + PKR 110 + PKR 10 + PKR 1 = PKR 200 ( APPROX)
Cost of one inappropriate fluid = 200 x 2500 = PKR 500000/ DAY
There are thirty days in a month = 200 x 2500 x 30 = PKR 15,000,000 year
There are 12 months in a year =
PKR 180,000,000 / year

16. Research shows that audit and feedback is an
effective educational strategy and helps participants
analyze their performance and plan effective
responses to improve their performance.

20. Audit Cycle

21. Steps of Audit Cycle
Scope
Select
standards
Collect data
interpret
results
Change
implementation

22. Common areas in the scope of an audit
include:
Mortality And Significant Morbidity,
Length Of Hospital Stay,
Readmission Rates,
Positive And Negative Outcomes,
Operation Specific Complications,
Process Of Care, Such As Pre-
operative Care,
Use Of Investigations,
Justification Of Management; And
Patient Satisfaction.

23. Steps of Audit Cycle
Scope
Select
standard
s
Collect data
interpret
results
Change
implementation

28. P.I.C.O.
Population Intervention Comparision
Outcome

32. Steps of Audit Cycle
Scope
Select
standards
Collect
data
interpret
results
Change
implementation

33. 6 W Questions !!
Who
How
What
Why
Where
When

34. Steps of Audit Cycle
Scope
Select
standards
Collect data
interpret
results
Change
implementation

35. Steps of Audit Cycle
Scope
Select
standards
Collect
data
interpret
results
Change
implemen
tation

36. Steps of Audit Cycle
Re-
Start
Select
standards
Collect
data
interpret
results
Change
implemen
tation