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Surgical Audit: Definition and Process

This document defines and discusses clinical audit, research, and service evaluation in healthcare. It begins by defining clinical audit as a quality improvement process that systematically reviews care against criteria to improve outcomes. It notes that clinical audits measure performance against predetermined standards, do not involve new interventions or randomization, and aim to answer whether a service meets a standard. The document contrasts this with research, which aims to generate new knowledge by testing new treatments or regimens, and may involve randomization or additional data collection. It also briefly defines service evaluation, which measures current services without reference to standards.

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Riya Shinde
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901 views16 pages

Surgical Audit: Definition and Process

This document defines and discusses clinical audit, research, and service evaluation in healthcare. It begins by defining clinical audit as a quality improvement process that systematically reviews care against criteria to improve outcomes. It notes that clinical audits measure performance against predetermined standards, do not involve new interventions or randomization, and aim to answer whether a service meets a standard. The document contrasts this with research, which aims to generate new knowledge by testing new treatments or regimens, and may involve randomization or additional data collection. It also briefly defines service evaluation, which measures current services without reference to standards.

Uploaded by

Riya Shinde
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
  • Introduction to Surgical Audit: Introduces the concept of surgical audit and its importance in clinical practice.
  • Definition of Audit: Defines what clinical audit entails and its role in improving patient care through systematic review.
  • Importance of Audit in Surgery: Highlights the essential role of audits in surgery with a quote from Hugh Brendon Devlin.
  • Audit, Research, and Evaluation: Explains the differences and connections between conducting audits, research, and evaluations.
  • Clinical Audit Process: Outlines the process and steps involved in conducting a clinical audit.
  • The Audit Cycle: Illustrates the audit cycle stages from identification of problems to re-auditing.
  • Steps in Conducting an Audit: Details the steps needed to carry out a comprehensive audit involving a multidisciplinary team.
  • Research Study Design: Discussion on designing a research study within the context of limited evidence in audit projects.
  • Types of Research: Differentiates between quantitative and qualitative research types, including their methodologies and applications.
  • Considerations Before Undertaking Research: Provides key questions and considerations necessary before starting a research study.
  • Types of Study Designs: Describes various study designs, their definitions, and differences.
  • Sample Size Calculation: Guidelines for calculating sample sizes in research to ensure valid conclusions.
  • Research Databases: Lists major databases for research and literature access, essential for conducting audits and evaluations.
  • Service Evaluation: Evaluates current service practices without a standard comparison, focusing on practical evaluations.
  • Conclusion: Concludes the document with closing remarks and expressions of gratitude.

AUDIT IN SURGERY

References
Bailey and Love Surgery
(27Ed)
Google , Wikipedia

Dr DASARI ANURAG
DEFINITION OF 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".
“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)
CLINICAL AUDIT
• Designed and conducted to produce information to inform the delivery
of best care
• Designed to answer the question: 'Does this service reach a
predetermined standard?’
• Measures against a standard
• Involves an intervention in use ONLY. (The choice of treatment is that
of the clinician and patient according to guidance, professional
standards and/or patient preference)
• Usually involves analysis of existing data but may include
administration of simple interviews or questionnaires
• No allocation to interventions: the health professional and patient
have chosen intervention before clinical audit
• No randomisation
1. Define the audit question in a multidisciplinary team;
2. Identify the body of evidence and current standards;
3. Design the audit to measure performance against agreed standards
based on strong evidence. Seek appropriate advice (local audit
department in UK) and ensure institutions have agreed to undertake
the audit;
4. Measure over an agreed interval;
5. Analyse results and compare performance against agreed standards;
6. Undertake gap analysis:
• if all standards are reached, reaudit after an agreed interval;
• if there is a need for improvement, identify possible interventions
such as training, and agree with the in volved parties;
7. Reaudit.
Research study
• During the design of the audit project, it might become
apparent that there is a limited body of evidence
available.
• In this case, the study should be structured as a research
proposal.
• Research is designed to generate new knowledge and
might involve testing a new treatment or regimen.
• The attempt to derive generalisable new knowledge
including studies that aim to generate hypotheses as well
as studies that aim to test them
Quantitative Research
• Designed to test a hypothesis
• May involve evaluating or comparing interventions, particularly new ones
• Study design may involve allocating patients to intervention groups

Qualitative Research
• Identifies/explores themes following established methodology;
• Usually involves studying how interventions and relationships are experienced
• Uses a clearly defined sampling framework underpinned by conceptual or
theoretical justifications.

1. Addresses clearly defined questions, aims and Objectives


2. Usually involves collecting data that are additional to those for routine care but
may include data collected routinely. May involve Rx, samples or Ix additional to
routine care
3. May involve randomisation
Questions to answer before undertaking research
• Why do the study?
• Will it answer a useful question?
• Is it practical?
• Can it be accomplished in the available time and with the
available resources?
• Will the project benefit from collaboration to increase
numbers or make best use of high tech equipment?
• What findings are expected?
• What are the research governance requirments?
• What are the ethical issues?
• What impact could it have?
Sample size
1. Calculating the number of patients required to perform a
satisfactory investigation is an important prerequisite to any
study.
2. An incorrect sample size is probably the most frequent reason
for research being invalid.
3. Often, surgical trials are marred by the possibility of error caused
by the inadequate number of patients investigated.

• Type I error. Benefit is perceived when really there is none (false


positive)
• Type II error. Benefit is missed when it was there to be found (false
negative).
Service evaluation
• Designed and conducted solely to define or judge current care
• Designed to answer the question: 'What standard does this
service achieve?’
• Measures current service without reference to a standard
• Involves an intervention in use ONLY. (The choice of treatment is
that of the clinician and patient according to guidance,
professional standards and/or patient preference)
• Usually involves analysis of existing data but may include
administration of simple interviews or questionnaires
• No allocation to intervention: the health professional and patient
have chosen intervention before service evaluation
• No randomisation

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