Surgical audit in a district general hospital: a stimulus for improving patient care

A computerised audit system was used to monitor clinical and administrative management of surgical patients in a District General Hospital. In one year (1985) there were 1,060 discharges from 27 beds (39.3 patients/bed/year). Operative treatment was required in 652 patients but 408 patients did not undergo surgery. Of this latter group the majority were admitted with abdominal pain (179 patients) and a final diagnosis was made in only 76 patients. The majority of patients were discharged within one week of admission, but 94 patients (8.9%) were admitted for more than three weeks. Of this group 42.5% could not be discharged because of poor home and social circumstances. The results of this study suggest that management could be improved without compromising patient care, in particular by providing adequate facilities for day care surgery and by improving social and geriatric support services. Reductions in staff or bed numbers without providing such improvements will lead to a significant reduction in patient care.