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Quality assurance in surgical practice

Published online by Cambridge University Press:  05 December 2011

S. J. Nixon
Affiliation:
Western General Hospital, Edinburgh
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Extract

Audit is the critical evaluation of medical practice to effect an improvement in quality of service. Quality has been described as ‘getting it right the first time’ and audit as asking ‘whether you are doing the right thing and you doing it right?’. Surgeons are acutely aware of the penalty paid by the patient when he ‘gets it wrong’. Immediate complications such as wound infection and anastomotic leakage may require additional therapy, delay discharge from hospital, necessitate further surgery or even lead to death. Late complications may result in recurrence of the presenting pathology or complications which cause more distress than the original disease. Surgery and audit seem to be closely linked and naturally associated. Surgical skills have developed immeasurably, no doubt accelerated by the realisation of the penalties of failure. Fortunately the cost of poor performance to the surgeon is no longer to have ones hand cut off as it was in 1750 BC under the rule of King Hammurabi of Babylonia.

Type
Research Article
Copyright
Copyright © Royal Society of Edinburgh 1993

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References

Anderson, I. D., Woodford, M., De Dombal, F. T. & Irving, M. 1988. Retrospective study of 1000 deaths from injury in England and Wales. British Medical Journal 296, 1305–8.CrossRefGoogle ScholarPubMed
Bailey, I. S., Karran, S., Toyn, K., Brough, P., Ranaboldo, C., & Karran, S. J. 1992. Community surveillance of complications after hernia surgery. British Medical Journal 304, 469–71.CrossRefGoogle ScholarPubMed
Becker, G. J., Strauch, G. O. & Saranchak, H. G. 1984. Outcome and cost of prolonged stay in the surgical intensive care unit. Archives of Surgery 119, 1338–42.CrossRefGoogle ScholarPubMed
Blacklock, A. R. E. & Gunn, A. A. 1976. The acute abdomen in the accident and emergency department. Journal of the Royal College of Surgeons of Edinburgh 21, 165–9.Google ScholarPubMed
Buck, N., Devlin, H. B. & Lunn, J. N. 1987. Report of a Confidential Enquiry into Perioperative Deaths (CEPOD). London: Nuffield Provincial Hospitals Trust and Kings Fund.Google Scholar
BUPA 1989. British United Provident Association. BUPA Schedule of Procedures London.Google Scholar
Cale, A. R. J., King, P. M. & Macleod, D. A. D. 1991. Practical surgical audit; a morbidity profile. Journal of the Royal College of Surgeons Edinburgh 36, 41–4.Google ScholarPubMed
Campling, E. A., Devlin, H. B. & Lunn, J. N. 1989. The Report of the National Confidential Enquiry into Perioperative Deaths. London: Royal College of Surgeons of England.Google Scholar
Campling, E. A., Devlin, H. B. & Hoile, R. W. 1990. The Report of the National Enquiry into Perioperative Deaths. London: Royal College of Surgeons of England.Google Scholar
Chadwick, L., Jaffe, V. & Galland, R. B. 1991. General surgery with a special interest in vascular surgery: is the tail starting to wag the dog? Journal of the Royal College of Surgeons of Edinburgh 36, 312–13.Google ScholarPubMed
Clason, A. E. 1989. Acute ischaemia of the lower limb: the effect of centralising vascular surgical services on morbidity and mortality. British Journal of Surgery 76, 592–3.CrossRefGoogle ScholarPubMed
Commision on the Provision of Surgical Services. 1988. Report of the Working party on the Management of Patients with Major Injuries. 1988. London: Royal College of Surgeons of England.Google Scholar
Copeland, G. P. 1992. Surgical scoring, risk assessment and the surgeon. Journal of the Royal College of Surgeons Edinburgh 37, 145–8.Google ScholarPubMed
Copeland, G. P., Jones, D. & Walters, M. 1991. POSSUM: a scoring system for surgical audit. British Journal of Surgery 78, 355–60.CrossRefGoogle ScholarPubMed
Court Brown, C. M. 1989. Care of accident victims (letter). British Medical Journal 298, 115–6.Google Scholar
Davies, A. H. & Horrocks, M. J. R. 1989. Patient evaluation and complications of day case heriorrhaphy under local anaesthetic. Journal of the Royal College of Surgeons Edinburgh 34, 137–9.Google ScholarPubMed
Davies, M. J., Wilson, R. G. & Nixon, S. J., 1992. Implantable venous access catheters: what the patients say. Journal of the Royal College of Surgeons Edinburgh 37, 125–6.Google ScholarPubMed
De Dombal, F. T., Leaper, D. J., Staniland, J. R., McCann, A. P. & Horrocks, J. C. 1972. Computer aided diagnosis of acute abdominal pain. British Medical Journal 2, 913.CrossRefGoogle ScholarPubMed
Dunn, D. C. & Dale, R. F. 1986. Combined computer generated discharge documents and surgical audit. British Medical Journal 292, 816–18.CrossRefGoogle ScholarPubMed
Dunn, D. C. & Fowler, S. 1992. Comparitive audit: an experimental study of 148882 general surgical admissions during 1990. British Journal of Surgery 79, 1073–6.CrossRefGoogle Scholar
Dunn, D. C., Dale, R. F., Gumpert, J. R. W. & Duffy, T. J. 1992. Combined surgical audit by microcomputer involving units in four health regions. Annals of the Royal College of Surgeons England 7, 4753.Google Scholar
Ellis, B. W., Michie, H. R., Esufali, S. T., Pyper, R. J. D. & Dudley, H. A. F. 1987. Development of a microcomputer based system for surgical audit and patient administration: a review. Journal of the Royal Society for Medicine 80, 157–61.CrossRefGoogle ScholarPubMed
Forster, D. P. 1977. Mortality and resource allocation. Lancet 1, 997.CrossRefGoogle ScholarPubMed
Gilmore, O. J. A., Griffiths, N. J. & Connolly, J. C. 1980. Surgical audit: comparison of the workload and results of two hospitals in the same district. British Medical Journal 281, 1050–2.CrossRefGoogle Scholar
Goldacre, M. J. & Harris, R. I. 1980. Mortality, morbidity, resource allocation and planning: a consideration of disease classification. British Medical Journal 281, 1515–9.CrossRefGoogle ScholarPubMed
Harris, P. L. 1992. National vascular registry and audit. Medical Audit News 8, 121.Google Scholar
HMSO 1989. Secretaries of State for Health, Wales, Northern Ireland and Scotland. Working for Patients. London.Google Scholar
Johnson, A. G. 1992. Audit and ethics. Medical Audit News 2, 119–20.Google Scholar
Jones, S. M. & Collins, C. D. 1990. Scoring complexity of operative procedures as a means of analysing workload. British Medical Journal 301, 324–5.CrossRefGoogle ScholarPubMed
Kind, P. 1990. Outcome measurement using hospital activity data; deaths after surgical procedures. British Journal of Surgery 77, 1399–402.CrossRefGoogle ScholarPubMed
King, P. M., Bradbury, A. & Macleod, D. A. D. 1992. Auditing inpatient morbidity. Medical Audit News 2, 2324.Google Scholar
Knaus, W. A., Draper, E. A. & Wagner, D. P. 1985. APACHE 11: a severity of disease classification system. Critical Care Medicine 13, 818–29.CrossRefGoogle Scholar
Lunn, J. N. & Mushin, W. W. 1982. Mortality associated with anaesthesia. London: Nuffield Provincial Hospital Trust.CrossRefGoogle Scholar
McArdle, C. S., Hole, D., Hansell, D., Blumgart, L. H. & Wood, C. B. 1990. Prospective study of colorectal cancer in the West of Scotland: 10 year follow up. British Journal of Surgery 11, 280–2.Google Scholar
Michaels, J. A. & Galland, R. B. 1991. Prospective audit of vascular surgical emergencies in a District General Hospital. British Journal of Surgery 78, 1271–2.CrossRefGoogle Scholar
Michaels, J. A., Reece Smith, H. & Faber, R. G. 1992. Case control study of patient satisfaction with day case and inpatient inguinal hernia repair. Journal of the Royal College of Surgeons of Edinburgh 37, 99100.Google ScholarPubMed
Mortenson, N. 1989. Wide variation in surgical mortality (Editorial). British Medical Journal, 298, 344–5.CrossRefGoogle Scholar
Nixon, S. J. 1992. Does audit result in change in practice? The Lothian surgical experience. Quality in Health Care 1 (Suppl.) 25–7.CrossRefGoogle Scholar
Nixon, S. J., Brown, D. T. & Goulbourne, L. 1992. The Scottish Mortality Study. Clinical Resource and Audit Group Occasional Paper 16.Google Scholar
O'Boyle, C. A. 1992. Assessment of quality of life in surgery. British Journal of Surgery 79, 395–8.CrossRefGoogle ScholarPubMed
Pettigrew, R. A., Burns, H. J. G. & Carter, D. C. 1987. Evaluating surgical risk; the importance of technical factors in determining outcome. British Journal of Surgery 74, 791–4.CrossRefGoogle ScholarPubMed
Rees, J. L. 1982. Accuracy of hospital activity analysis data in estimating the incidence of proximal femoral fracture. British Medical Journal 284, 1856–7.CrossRefGoogle ScholarPubMed
Roberts, J., Smallwood, J. A., Chant, A. D. B. & Webster, J. H. H. 1990. Local audit in vascular surgery. Annals of the Royal College of Surgeons England 12, 287–90.Google Scholar
Royal College of Surgeons of England Commision on the the Provision of Surgical Services 1985. Guidelines for day case surgery. London: Royal College of Surgeons of England.Google Scholar
Royal College of Surgeons of England. 1991. Guidelines for surgical audit by computer. London: Royal College of Surgeons of England.Google Scholar
Ruckley, C. V. 1990. More day surgery (letter). British Medical Journal 301, 1213. Schipper H. 1983. Why measure quality of life? Canadian Medical Association Journal 128, 1367–70.CrossRefGoogle Scholar
Schofield, P. F., Walsh, S. & Tweedle, D. E. F. 1986. Survival after treatment of the carcinoma of the rectum. British Medical Journal 293, 496–7.CrossRefGoogle ScholarPubMed
Secretaries of State for Health, Wales, Northern Ireland and Scotland, 1989. Working for patients (Cmnd 555). London: HMSO.Google Scholar
Seymour, D. G. & Pringle, R. 1982. A new method of auditing surgical mortality rates: application to a group of elderly general surgical patients. British Medical Journal 284, 1539–42.CrossRefGoogle ScholarPubMed
Trunkey, D. D. 1988. A time for decisions. British Journal of Surgery 75, 937–9.CrossRefGoogle ScholarPubMed
Whates, P. D., Birzgalis, A. R. & Irving, M. 1982. Accuracy of hospital activity analysis codes. British Medical Journal 284, 1857–8.CrossRefGoogle Scholar
Yates, D. W. 1988. Action on accident victims. British Medical Journal 297, 1419–20.CrossRefGoogle ScholarPubMed