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Surgical audit: Comparison of the work load and results of two hospitals in the same district
Insights
Surgical audit comparing two London hospitals revealed differences in patient demographics and complication rates. Despite similar antibiotic use, Hackney Hospital had higher surgical site infections and post-operative deaths, prompting improvements.
Area of Science:
- Surgery
- Public Health
- Health Services Research
Background:
- Surgical audits are crucial for evaluating and improving healthcare delivery.
- Comparing surgical units within the same district allows for targeted quality improvement initiatives.
- Understanding patient populations and outcomes is essential for resource allocation and patient safety.
Purpose of the Study:
- To compare patient demographics, workload, and outcomes of two similar surgical units.
- To identify variations in surgical practice and patient complications between St Bartholomew's Hospital and Hackney Hospital.
- To inform quality improvement measures based on audit findings.
Main Methods:
- A computer-assisted surgical audit was conducted.
- Data collected included patient type, workload, and results from two surgical units.
- Comparison focused on admission numbers, patient origin, complication rates, mortality, and length of stay.
Main Results:
- Hackney Hospital admitted more patients (902) than St Bartholomew's (736).
- St Bartholomew's had a higher proportion of elective admissions (70% vs. 49%) and fewer local patients (36% vs. 86%).
- Hackney Hospital experienced higher surgical site infection rates (9% vs. 6%) and significantly more post-operative deaths (32 vs. 6), despite identical antibiotic policies.
Conclusions:
- The surgical audit identified significant differences in patient populations and outcomes between the two hospitals.
- Hackney Hospital's higher complication and mortality rates indicated a need for targeted interventions.
- The audit led to the implementation of enhanced venous thrombosis prophylaxis and improvements in anesthetic services and intensive care at Hackney Hospital.
Abstract:
Surgical audit is being undertaken to monitor and compare (by computer) the type of patient, work load, and results of two similar surgical units. Both units are in the City and Hackney District of London, one at St Bartholomew's Hospital and the other at Hackney Hospital. During 1978, 736 patients were admitted by the unit at St Bartholomew's Hospital and 902 by the unit at Hackney. At St Bartholomew's 70% of admissions were elective compared with 49% at Hackney, where 86% of patients lived within the district compared with only 36% at St Bartholomew's. The wound was the commonest site for complications, infection affecting 9% of those at Hackney and 6% at St Bartholomew's, despite identical antibiotic policies. There were six post-operative deaths at St Bartholomew's and 32 at Hackney. In both hospitals the length of stay was similar, 50% of patients being discharged within one week and 80% within two weeks. As a result of the audit a vigorous venous thrombosis prophylactic regimen has been instituted, and at Hackney the anaesthetic department has been strengthened and a new intensive care unit opened.