The document provides an overview of surgical audit, which involves systematically reviewing surgical care against explicit criteria to improve quality. It discusses the aims of audit including improving patient care and education. The types of audit - structure, process, and outcome - are described. Structure looks at resources, process examines procedures, and outcome assesses results. The audit cycle is outlined as determining scope, selecting standards, collecting data, interpreting results, and taking appropriate action. Surgical audit is presented as an educational process aimed at continuous quality improvement to optimize patient outcomes.

1. Surgical Audit
Capt Htet Ko
PG-2
ORL-HNS
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2. 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.
• The purpose is to bring about improvements in clinical practice and
patient outcome
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3. 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.
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4. 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
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5. Types of Audit
• Retrospective or Concurrent
• Individual, Unit, Hospital, State, Regional, National
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6. 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
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7. 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
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8. • Confidentiality, patient privacy
• Relevance to common clinical problems.
• Clear standards set by peer assessment
• Education not punishment
• Audit should lead to appropriate action
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9. Audit Parameters
• Audit of Structure
• Audit of Process
• Audit of Outcome
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10. 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
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11. 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
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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 favoured by surgeons
• Doesn’t always tell the whole story
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13. The Audit Cycle
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14. Determining Scope
• Should be clearly defined
• Time bound
• Easy to measure
• Relevant to performance and outcome
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15. 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
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16. Data Collection
• Determine source of information
• Identify relevant information
• Assess accuracy of data
• Assess need to modify data
• Determine minimum acceptable quantity of data
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17. 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
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18. 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
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19. 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
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20. 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.
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21. Surgical Ethics
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22. Ethics
• The word ethics is derived from the Greek word ethos which means
character.
• To put it formally ethics is the branch of philosophy that defines what
is good for the individual and for society and establishes the nature of
obligations, or duties, that people owe themselves and one another.
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23. Surgical Ethics
Surgical ethics refers to the moral principles and guidelines that govern
the conduct and decision-making of surgeons and other healthcare
professionals involved in surgical procedures.
It encompasses a range of ethical considerations specific to the field of
surgery, including patient autonomy, beneficence, non-maleficence,
justice, and professional integrity. These principles guide surgeons in
providing the best possible care for their patients while upholding the
highest ethical standards.
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24. The principles of surgical ethics
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25. Patient Autonomy:
• This principle recognizes the patient's right to make informed
decisions about their own healthcare.
• Surgeons must respect the autonomy of their patients by providing
them with accurate and comprehensive information about their
condition, treatment options, risks, and benefits.
• They should involve patients in the decision-making process and
honor their choices, as long as they are deemed medically and
ethically appropriate.
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26. Beneficence:
• The principle of beneficence emphasizes the duty of surgeons to act in
the best interests of their patients.
• Surgeons should strive to maximize the benefits and well-being of
their patients by providing skilled and compassionate care.
• This principle encourages surgeons to continuously update their
knowledge and skills to ensure the delivery of optimal surgical
outcomes.
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27. Non-Maleficence:
• Non-maleficence refers to the obligation of surgeons to do no harm to
their patients.
• Surgeons must strive to minimize the risks and potential harm
associated with surgical procedures.
• They should prioritize patient safety, carefully evaluate the risks and
benefits of surgical interventions, and take necessary precautions to
prevent complications or adverse outcomes.
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28. Justice:
• The principle of justice underscores the importance of fairness and
equitable distribution of healthcare resources.
• Surgeons should ensure that access to surgical care is based on clinical
need and not influenced by factors such as socioeconomic status, race,
or gender.
• They should allocate resources appropriately, advocate for equitable
healthcare policies, and strive to eliminate disparities in surgical care.
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29. Professional Integrity:
• Surgeons have a responsibility to maintain professional integrity,
which includes honesty, transparency, and accountability.
• They should communicate truthfully and effectively with patients,
colleagues, and other healthcare professionals.
• Surgeons should adhere to professional codes of conduct, maintain
confidentiality, and disclose conflicts of interest that may affect
patient care.
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30. Surgical ethics provides a framework for surgeons and healthcare
professionals to navigate complex ethical dilemmas, make sound
decisions, and ensure the provision of high-quality and morally grounded
surgical care.
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31. COMMUNICATION
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32. Defination
• The word “communication” has been derived from LATIN word
“Communicare”.
• “Communicare” means to share.
• The sharing of information ,knowledge ,understanding ,and thoughts
to other is called communication.
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33. • There are two parties required for Communication.
• First party calls as “Sender” and second calls as “Receiver”.
• Absence of these two parties communication can not take place.
• It is termed effective only when the receiver receive the message
intended by the sender in the same perspective. otherwise, it is
miscommunication.
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34. • Doctor-patient communication is a vital aspect of healthcare that
involves the exchange of information, understanding, and decision-
making between a healthcare provider and their patient.
• Effective communication plays a crucial role in building trust,
establishing a strong doctor-patient relationship, and ultimately
improving patient outcomes.
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35. Active Listening:
• Doctors should listen attentively to their patients, allowing them to
express their concerns, symptoms, and feelings without interruption.
• Active listening helps doctors understand the patient's perspective and
promotes a sense of empathy.
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36. Clear and Simple Language:
• Doctors should use plain language instead of medical jargon to
explain medical conditions, diagnoses, and treatment options.
• This ensures that patients can fully comprehend the information and
actively participate in their own healthcare decisions.
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37. Empathy and Respect:
• Demonstrating empathy and respect towards patients helps establish a
supportive environment where patients feel comfortable discussing
their health issues openly.
• Doctors should acknowledge the emotional aspects of a patient's
experience and show understanding and compassion.
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38. Non-Verbal Communication:
• Non-verbal cues such as eye contact, facial expressions, and body
language can significantly impact doctor-patient communication.
• Maintaining appropriate eye contact and using open and welcoming
body language can help create a positive and trustworthy atmosphere.
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39. Time and Availability:
• Doctors should allocate sufficient time for patient consultations to
ensure that patients have ample opportunity to discuss their concerns
and ask questions.
• Additionally, being accessible and responsive to patient inquiries and
providing clear instructions for follow-up can enhance the doctor-
patient relationship.
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40. Shared Decision-Making:
• Doctors should involve patients in the decision-making process
regarding their treatment options.
• By explaining the risks, benefits, and alternatives, patients can make
informed choices aligned with their values and preferences.
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41. Clarification and Summarization:
• Doctors should confirm their understanding of a patient's concerns
and provide a summary of the discussion.
• This helps prevent misunderstandings and allows patients to confirm
that their concerns have been heard and addressed.
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42. Cultural Sensitivity:
• Healthcare providers should be mindful of patients' cultural
backgrounds, beliefs, and values.
• Understanding cultural nuances and tailoring communication
accordingly can foster trust and avoid misinterpretations.
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43. Patient Education:
• Doctors should provide educational materials or reliable resources to
enhance patients' understanding of their health conditions, treatments,
and self-care practices.
• This empowers patients to actively participate in managing their own
health.
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44. Follow-up and Continuity:
• After consultations, doctors should follow up with patients to check
on their progress, address any concerns, and reinforce treatment plans.
• Continuity of care helps strengthen the doctor-patient relationship and
improves patient outcomes.
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45. Remember that effective doctor-patient communication is a two-way
process that requires active participation from both parties. Open and
honest communication helps build trust, ensures patient satisfaction, and
leads to better healthcare outcomes.
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46. THANK YOU
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