Four Year Surgical Audit at Department of Bhurgri Hospital

Clinical audit is not a process that has been defined as “a quality improvement process that seeks to improve patient care and outcomes through systemic review of care against explicit criteria and the implementation of change:

Prof David Johnson defined audit as “means of quality control for medical practice by which the profession shall regulate its activities with the intention of improving overall patient care”

So when it comes to the field of medicine it becomes the mean which represents medical practice quality control, in the surgical audit, In the light of his philosophy audit emerged and evolved to fulfill the needs and interests

This quality should support administrators to prepare enough resources for these important movements. It is hard to maintain the quality and to apply, so we need to measure the differences in result. A good surgeon should never conceal his or her defects but must gain knowledge from them in order to perform best for his patients and improve his practice. It also confirms the prevention and restriction of malpractice and promotes patient care as an outcome to it.

Clinical audits combined with feedback are a well-established quality improvement intervention, which is acceptable to practitioners and widely used in primary care

The term audit is usually associated with the accounting and it implies the numerical review by an investigator for the prevention of fraud, but in a clinical setting, it is the collection of the data for the purpose of setting professional standards, assessing clinical performances and modifying the clinical practice2. The evidence that quality assessment and quality assurance audits have improved medical practices is not much stronger than they have shown that the objective of auditing and the role of auditors are constantly changing and auditing is seen to be evolving all the times6. Ernest Hey Amory Codman introduced Clinical Audit in the United States (1910)7. Many studies suggest that medical care evaluation studies have a marginal effect on the practitioner

A study of the prior development of inspecting for the clinical audit is not available except in few Hospitals. It is not a regular practice to management surgical audit on daily basis, therefore proper clinical data is not available which can be reviewed and analyzed in terms of morbidity, mortality and other clinical outcomes, in order to improve the overall clinical practice2. This study will help to see the morbidity and mortality. This study will also provide an planning and idea for future risks management from the current medical/surgical record. The aim of the study is to tell the analysis of all admitted cases & mortality in surgical department at Bhurgri Hospital Matli

This Audit was conducted at Department of General Surgery at Bhurgri Hospital Matli, from July 2014 to November 2017. The Data for this study was collected from computer software (Hospital Management Software) and proforma which contains patient’s basic information, statistical data, mode of admission to surgical department like emergency or outpatient department or referred from other Clinic for management i.e. operation or conservative treatment, the result of management i.e. cured, referred or death. Admissions’ detail was noted from computer software that registers patient’s statistical data, and other details like date, admission’s mode. Details of the surgical procedures, i.e. emergency or elective, were recorded from the computerized data maintained by the paramedical staff and Receptionist at the reception of major OT and the department of Bhurgri Hospital.

The following result was obtained during the Four years of the Study period total number of 1138 patients admitted. Among them, 50% (n=569) were males and 50% were females (n=569). Hepatitis B was reactive in 1.84% (n=21) patients and for Hepatitis C was reactive in 8.34% (n=95) patients. The minimum inpatient admission stay was only 1 day while the longest duration of stay was 12 days. The result shows that 44% (n=500) procedures were performed in an emergency and 56% (n=638) were elective. From them, Appendectomy was the most common emergency procedure which was done in 33.65% (n=383), while cholecystectomy was the commonest elective procedure done in 21.47% (n=137). Majority of patients (99.5%) were discharged with full recovery and there were n=6 (0.5%) deaths.

In the developing world, a successful national method for audit and qualified audit services are available. The surgical audit has become a major part of the modern practice of surgery and a basic requirement for the surgeons, continuing professional development and commitment by further analysis thereby resulting in improved practice and safety. In our study, a total of 1138 patients were admitted in Hospital through different modes of admission. In this study frequency of elective procedures were much higher than those performed in an emergency. Appendectomies were at the top among all procedures. Among all the cases appendectomies were the most commonly performed procedures followed by exploratory laparotomies in an emergency. Qureshi et al9 and Bhatti et al10 also reported appendiceal diseases as a most common emergency in their audit. Another study showed acute appendicitis as the commonest emergency procedure

A local study reported similar results with a higher number of cholecystectomies in elective procedures followed by breast surgeries and one of the local studies depicted inguinal hernia is the most common elective procedure

Comorbidities included diabetes hypertension and tuberculosis cases. A British study conducted on minor surgical procedures at general practitioner level, reported head and face being the commonest sites observed 2. In our Study, the mortality is 0.5% which is less than other local studies (1.5%) 5 and (1.2%) 10. In an international study, McGuire et al reported 1.8% mortality in the audit of 44,603 surgeries13. The mortality rate of Scottish study after emergency surgery is high (5.1%).2 It is suggested that proper structured surgical audit is done regularly for a good surgical practice. Knowledge of the current pattern of admissions, diseases spectrum and health care resources should be known, as it is beneficial for both the patient and the clinician14.

Elective procedures were 56% of total operated cases in four years, while 44% were operated in an emergency. We suggest the need to assessing surgical work in the hospitals and immediate performance of a surgical audit of admissions and procedures performed in the hospitals. As, unless we cannot know the diseases spectrum and the changes occurring in the pattern of admissions, proper and better health care planning becomes difficult.