surguical audit

1. SURGICALAUDIT & RESEARCH

2. “ … surgery without audit is like playing cricket
without keeping the score.”
(Hugh Brendon Devlin 1932-1998,
Founding Director of the Surgical Epidemiology and Audit
Unit, Royal College of Surgeons of England)

3. DEFINITION - AUDIT
• Clinical audit is a quality improvement process that seeks to improve
patient care and outcomes through systematic review of care against
explicit criteria and the review of change. (NICE 2002)
• The word ‘auditing’has been derived from Latin
word “audire” which means “to hear”.

4. INTRODUCTION
• Clinical audit is a process used by clinicians who seek to improve
patient care.
• The process involves comparing aspects of care (structure, process &
outcome) against explicit criteria.

5. CARE ASPECTS
 STRUCTURE.
 PROCESS.
 OUTCOME.

6.  Structure – what is in place
• The people, their training, their knowledge, the way they are led, the
equipment, their organization, the way they are paid, etc.

7.  Process – what you do
• How referrals are processed, what diagnostic tests are done, the antibiotics
that are used, the use of intensive care, the policy of feeding & mobilization
after surgery, the discharge policy, etc.

8. Outcome – the results you get
• Wound dehiscence rate, readmission rates, mortality, reduction in
symptoms, improvement in quality of life, return to work, etc.

9. EXPLICIT CRITERIA
 If the care falls short of the criteria chosen, some change in
the way that care is organized is proposed, it may be
required at one of many levels:
• An individual who needs training
• An instrument that needs replacing

10. • At team level e.g. nurses undertaking procedures instead of, or in addition to,
doctors
• At institutional level e.g. new antibiotic policy
• At regional level e.g. provision of a tertiary referral centre
• At national level e.g. screening programmes & health

11. THE AUDIT CYCLE
Problem or objective identified
Criteria agreed and standards
set
Audit (Data collected)
Identify areas for
improvement
Make necessary changes
Re-audit

12. STAGE 1:
PREPARING FOR AUDIT
• Selecting a topic
• Defining the purpose
• Planning

13. STAGE 2:
SELECTING CRITERIA
• Defining criteria
• Sources of evidence
• Appraising the evidence

14. STAGE 3:
MEASURING LEVEL OF
PERFORMANCE
• Planning data collection
• Methods of data collection
• Handling data

15. STAGE 4:
MAKING IMPROVEMENTS
 Identifying barriers to change
 Implementing change
 External relationships

16. STAGE 5:
SUSTAINING IMPROVEMENT
• Monitoring and evaluation
• Re-audit
• Maintaining and reinforcing improvement

17. DEFINITION - RESEARCH
• A systematic investigation undertaken to discover facts or relationships
and reach conclusions using scientifically sound methods.

18. TYPES OF RESEARCH STUDY
Types Definition
Observational –
Retrospective
Prospective
-Evaluation of condition or trt in a
defined population
-Analysing past events
-Collecting data contemporaneously
Case control Series of patients with a particular
disease or condition compared with
matched control patients
Cross-sectional Measurements made on a single
occasion,not looking at the whole
population but selecting a small
similar group & expanding results

19. Definition
Measurements are taken over a period of
time, not looking at the whole population
but selecting a small similar group and
expanding results.
Two or more treatments are compared.
Allocation to treatment groups is under the
control of the researcher.
Two randomly allocated treatments.
Includes a control group with standard
Types
 Longitudinal
 Experimental
 Randomised
 Randomised controlled
TYPES OF RESEARCH STUDY

20. RESEARCH – IDENTIFICATION
 Purpose – To provide new knowledge in order to set or change
standards.
 Methods – Randomised Trials etc…
 Data Analysis – Extensive statistical analysis.
 Ethical & Trust Approval - Always required.
 Sample size – statistically powered calculation.

21. • Significance –Statistical difference (hypothesis driven)
• Outcome – Improve knowledge
• Results, publications – Generalisable, publishable in peer
reviewed journals

22. GRADE System: Meaning of the 4 Levels of
Evidence.
Quality levels Current definition Previous concept
High High confidence in the correlation
between true
and estimated effect
Confidence that the estimation of
effect will not vary in subsequent
studies.
Moderate Moderate confidence in the
estimated effect. It is
possible that the true effect is very
different from
the estimated effect.
Subsequent studies may have a
significant impact on our
confidence in the estimate of effect
Low Limited confidence in the estimated
effect. The true
effect may be very different from the
estimated effect
It is very likely that subsequent
studies change our
confidence in the estimate of effect.
Very low Very little confidence in the
estimated effect. The true e
ffect is very probably different from
the estimated effect.
Any estimate is very uncertain