Audit of surgical audit.

Area of Science:

• Clinical Medicine
• Surgical Quality Improvement
• Health Services Research

Background:

• Clinical audits are crucial for monitoring and enhancing healthcare quality.
• Integrating audits into routine practice ensures continuous data collection and feedback.
• Surgeon-led audits with clerical support can be effectively implemented in large health authorities.

Purpose of the Study:

• To assess the impact of a routine clinical audit on surgical outcomes.
• To evaluate the effectiveness of a surgeon-led audit in reducing reoperations and mortality.
• To explore additional uses of clinical audit data beyond quality monitoring.

Main Methods:

• Implementation of a clinical audit within all hospitals of a large health authority.
• Integration of operation and death data into routine clinical recording.
• Feedback provided through annual reports with statistical analyses, commentaries, and peer discussions.

Main Results:

• Statistically significant decreases in reoperations for intra-abdominal complications, retained gallstones, arterial grafts, and amputations.
• Significant reduction in operative mortality for surgeries including benign biliary/pancreatic disease, large bowel resection, and aortic aneurysms.
• Demonstrated improvements in surgical quality and patient safety over a five-year period.

Conclusions:

• Routine clinical audits are effective tools for improving surgical quality and patient outcomes.
• Audit data provides valuable insights for service planning, monitoring specialisation, and postgraduate training.
• The study highlights the multifaceted benefits of a well-implemented clinical audit system.