Surgical audit is a process that systematically analyzes surgical care quality against standards to improve patient outcomes. It involves collecting data on parameters like mortality, complications and outcomes and comparing results to peers to identify areas for improvement. The goal is continuous quality improvement through a non-punitive, educational process. Surgical audit has existed for centuries but modern methods began in the early 1900s and involve retrospective review of existing data to guide practice changes.
This PPT is mainly oriented to the Final yr MBBS students who are preparing for their Final exams. The Audit cycle has taken up from Bailey & Love - 24th edition.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
This PPT is mainly oriented to the Final yr MBBS students who are preparing for their Final exams. The Audit cycle has taken up from Bailey & Love - 24th edition.
Principles of surgery. Day case surgery is a rapidly evolving surgical sub speciality that seeks to eliminate the need for prolonged admission in surgical patients and the attendant complications of prolonged immobilization. It is based on the documented evidence that most post op patients does not require specialised post op care and hence can be allowed to recover at home. This form of surgery appeals to patients and their families due to the fact that it allows only minimal interruption of patient's social life
Examination of Swelling in a patient is always a task for MBBS students. This PPT provides the students, how to elicit a history & also the easy way to examine a swelling.
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
This PPT describes about the Metabolic response to injury as given in Bailey & Love - 26th edition. It will be very useful for Final year MBBS students.
a basic and concise description of one of the most common clinical condition we encounter in our daily practice. this info has been gathered from several sources. feel free to point out any mistakes. :)
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Preoperative investigations and significance.
Dr.Moyukh Chowdhury, MBBS
Indoor Medical Officer,
Department of Surgery,
Sylhet Women's Medical College & Hospital,
Bangladesh .
compartment syndrome, causes, compartments of legs,compartments of forearm,compartments of hand,compartments of foot, compartments of arm,compartments of thigh,fasciotomy of leg,fasciotomy of forearm, fasciotomy of hand,fasciotomy of foot, fasciotomy of thigh, fasciotomy of arm
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Principles of Surgical Audit presented by Meeran Earfan, Kurdistan Board Trainee/General Surgery in Sulaimaniyah Teaching Hospital, As Sulaimaniyah, Iraq
Minimally invasive/accessed surgery comprises of robotic and non robotic surgery. Non robotic surgery includes laparoscopy, endoscopy, arthroscopy and etc.
This PPT describes about the Metabolic response to injury as given in Bailey & Love - 26th edition. It will be very useful for Final year MBBS students.
a basic and concise description of one of the most common clinical condition we encounter in our daily practice. this info has been gathered from several sources. feel free to point out any mistakes. :)
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Preoperative investigations and significance.
Dr.Moyukh Chowdhury, MBBS
Indoor Medical Officer,
Department of Surgery,
Sylhet Women's Medical College & Hospital,
Bangladesh .
compartment syndrome, causes, compartments of legs,compartments of forearm,compartments of hand,compartments of foot, compartments of arm,compartments of thigh,fasciotomy of leg,fasciotomy of forearm, fasciotomy of hand,fasciotomy of foot, fasciotomy of thigh, fasciotomy of arm
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Principles of Surgical Audit presented by Meeran Earfan, Kurdistan Board Trainee/General Surgery in Sulaimaniyah Teaching Hospital, As Sulaimaniyah, Iraq
Toll-like Receptors in Inflammation: Host Defense Webinar Series Part 2QIAGEN
Toll-like receptors (TLRs) have been implicated in both innate and adaptive immunity-induced inflammation, thereby playing critical roles in providing the host with short- and long-term protection against infections. This slidedeck provides an overview of the roles that TLRs play in the regulation of inflammation and solutions for studying these roles. An overview of TLR-mediated inflammation, the key signaling players involved in TLR-mediated inflammation, and the contribution of TLR-mediated inflammation to various physiological processes are also presented.
WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care.
1.To briefly describe the need for improved quality of admission falls prevention processes.
2.To introduce the use of a tool which allow teams to collect patient level data on specific admission falls quality determinants.
3.To demonstrate how this data can be easily submitted and analyzed through the Patient Safety Metrics system.
Watch the webinar: http://bit.ly/1KGkRgr
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
Synthetic biodegradable hyaluronic acid fillers are widely used as relatively safe injectable methods of lip augmentation but their duration is limited to only four months. Because of this many physicians use alternative non-biodegradable materials like polyacrylamide gels and polyvinyl acid, to create a longer lasting ‘semi-permanent’ product.
Bio in Blue (Polymekon, Brindisi, Italy) is high purity polyvinyl alcohol (8%) and water (92%). Polyvinyl alcohol is a non-toxic substance used in medicine as a drug-carrier and a substitute for human plasma expander.
Retrospective Study of nine cases requiring surgical correction of product migration of semi-permanent lip fillers Bio-Alcamid and Bio in Blue over 2 year period. Nine female patients in otherwise good health were referred to the author by aesthetic doctors in the UK and Ireland with moderate nodular swellings in their labial area over a period of two years. They all reported a history of their
lips having being injected with the cosmetic filler Bio in Blue or Bio-Alcamid at the site of the swelling to correct and project the labial profile.
Four of the patients had previously been injected with another type of HLA filler prior to the use of these semi-permanent type fillers.
The labial swellings were each worsening in appearance as time passed and the patients were emotionally distressed.
Numerous doctors had treated the patients with injections of Dexamethasone (40mgs/ml) or Triamcinolone (40 mg/ml) at intervals, with no resolution of the swelling.
There was no relevant medical history and the patient did not have any clinical evidence of autoimmune or allergic diseases. On palpation, each patient presented with firm longitudinal swellings measuring 3 cm × 2 cm along the lines of filler implant in each patient. The nodules were prominent anteriorly and projected from inside the oral cavity. The patients were all were willing to accept surgical correction and histological evaluation of their problem.
Surgical excisions were carried out by direct use of a size 11 scalpel blade, usually without the use of local anaesthesia, allowing the nodules to point under digital manipulation. The wound was cleaned and the vermillion tissues approximated in some cases with 5-0 Vicryl Rapide sutures (Ethicon, Inc) to achieve closure or haemostatis.
The operation sites healed well and most had healed within few days with no infection. Excision biopsies showed no evidence of foreign body giant cells or irregular crystalline structures and stopped
The wound was cleaned and the vermillion tissues approximated in some cases with 5-0 Vicryl Rapide sutures (Ethicon, Inc) to achieve closure or haemostatis.
The operation sites healed well and most had healed within a few days with no infection. Excision biopsies showed no evidence of foreign body giant cells or irregular crystalline structures and stopped
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
Quality is
degree to which health services for individuals and populations increase the likelihood of desired health outcomes (quality principles),are consistent with current professional knowledge (professional competency),and meet the expectations of healthcare users (the marketplace)
quality assurance slides include components, models, approaches, cycle of quality assurance is included in the slides.
the slide gives a brief ides regarding all the points and gives a comprehensive picture of the topic.
UNIT-IV M.sc I year NURSING AUDIT CHN.pptxanjalatchi
Nursing audit is the process of collecting information from nursing reports and other documented evidence about patient care and assessing the quality of care by the use of quality assurance programmes.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
2. Outline
• Introduction
• Historical Perspective
• Aims of Surgical audit
• Commonly audited Parameters
• Principles of Clinical Auditing
• Types of audit
• Conduct of surgical audit
• Value of audit
• Disadvantages and limitations of audits
• Conclusion
3. Introduction
• 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.
4. Introduction
• 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
5. Historical Perspective
• Has existed since antiquity
• 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 who
independently reported systems of reporting outcomes of
surgical care.
• In 1912-American College of Surgeons reported the need
to standardize hospitals and they set five minimum
standards
6. 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.
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
• Improves efficiency and guides resource allocation
• Improved education, training and feedback
• Healthy competition
8. Types of Audit
• Retrospective or Concurrent
• Individual, Unit, Hospital, State, Regional, National
9. Audit vs. Research
Audit
• To inform delivery of the
best care
• Measures against a
predetermined standard
• Usually involves analysis
of existing data or simple
questionnaires
• No allocation of patients
• No randomization
Research
• To produce generalizable
new knowledge
• Tests a hypothesis
• Usually involves collection of
new data e.g.. additional
Investigations
• Patients may be allocated to
test and control groups
• May involve randomization
10. Audit vs. Research
Audit
• Only used to assess
modalities currently in use
Research
• May be used to assess
new or experimental
modalities
11. Principles
• Objectivity
• Honesty
• Accurate and standard forms
• Complete medical records
• All that happened to the patient
• Result of investigations
• Post Op Notes
• Follow up
• Autopsy findings
• Records should be filed in an accessible manner
12. Principles
• Confidentiality, patient privacy
• Relevance to common clinical problems.
• Clear standards set by peer assessment
• Education not punishment
• Audit should lead to appropriate action
13. 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
15. Audit of Structure
• Concerned with amount and type of resources available
• No of hospital beds, staff numbers, nurse to patient ratio,
theatres suites, wards, equipment
• Easy to measure
• Does not necessarily correlate with quality or
effectiveness of care
16. Audit of Process
• Concerned with the amount and type of processes carried
out
• Time utilization, time to surgery (in specific emergencies),
operating time, down time
• More relevant than audit of structure
• Identifies problems in surgical practice and proffers
solutions
• Can be difficult to quantify
17. 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 favoured by surgeons
• Doesn’t always tell the whole story
19. Determining Scope
• Should be clearly defined
• Time bound
• Easy to measure
• Relevant to performance and outcome
20. 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
• Should define sentinel events
21. Data Collection
• Determine source of information
• Identify relevant information
• Assess accuracy of data
• Assess need to modify data
• Determine minimum acceptable quantity of data
22. Interpretation of Results
• Results should be presented regularly (e.g. monthly,
biannually)
• Results are evaluated by peers (e.g.. other surgeons or
other centres)
• Results should be compared to those of similar
centres/surgeons
• All sentinel events must be reviewed
• Quality issues should be identified
• Peer review is a learning process not for punishment or
bragging
23. Appropriate Action
• Recommendations and changes should be made based
on audit findings
• Staff should be educated on reasons behind each change
• Follow up
• Audit cycle should be repeated to assess effects of
changes
24. 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
25. Computers in Clinical Practice
• The availability of computers has significantly changed
the process of surgical audit
• Advantages: Easy storage and analysis of large amounts
of data
• Disadvantages: Translating and entering data to usable
formats, staff training, electricity
• Future trends: Electronic medical records
26. Local Experience
• Very little audit at individual and hospital level
• Morbidity and Mortality meetings
• Little training or emphasis on audit
• Poor and inconsistent data gathering
• Punitive mentality
27. 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
28. 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
quality improvement process seeking at improving patient care and outcomes through systematic review of care against explicit criteria to guide implementation of change
All encompassing
Aimed at improving patient outcomes and improving efficiency
Resources can be channeled to areas where they will give the most benefit
Retrospective: analyze past records
Concurrent: continuous assessment
Honesty, no cheating
Audit without action is pointless
Standardised forms to ensured data is collected in a consistent manner
Complete records including final outcome
Confidentiality, anonymization of data
Non punitive, not vindictive. For education, training and improvement
Audit parameters should be relevant to problems that exist in your local environment. Incidence of malaria in surgical inpatients. Not west Nile Virus
Compare statistics with similar centres e.g.. UCH
Rate of litigation
LUTH has a lot of theatre suites
Door to cath lab time in MI (US)
Time to work up patient
Time till return to work, patient satisfaction, litigation rate
Cherry picking
Adverse events: unplanned re-operation, excessive blood loss, post-op sepsis, death
Sentinel events: unexpected event involving the risk of death, or serious physical or psychological injury e.g.. loss of limb or function. Require immediate investigation and response. Not necessarily due to error
Takes considerable time and effort which can be better spent on patient care or research
Mob mentality, people only remember the bad stuff
Cherry picking
Most M&Ms as practiced in Nigeria don’t meet required criteria of surgical audit. No prescribed standards, no changes or follow up