Clinical audit of surgery in a large teaching hospital.
Practical peer review by means of a clinical audit requires complete documentation, critical assessment and open discussion of difficulties or errors in patient management. The quality of care in a large surgical department was monitored using weekly on-the-ward capture of complications and immediate feedback to involved surgeons. Retrospective peer review of surgical deaths judged the process of patient care in three categories--treatment, investigation and documentation; feedback was also provided. Seven of the 10 surgical services each collected morbidity data for at least 40 weeks in 1976 and 44 weeks in 1977. In 1978, 8 of the 10 services collected data for 50 weeks or more. The number of patients reviewed was 3520 in 1978. Of these, 822 (23%) had complications in 1976, 703 (16%) in 1977 and 918 (17%) in 1978. In 1976, 260 patients died; the quality of care was considered to have been adequate in 67%. In 1977, 278 patients died; in 76% the management was considered adequate. In 1978, 231 patients died; in 68% management was satisfactory. This clinical audit system is suitable for computer programming and can provide a complete and accurate report of the entire spectrum of complications.
D002170:Canada; D006748:Hospital Departments / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D009017:Morbidity; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011787:Quality of Health Care; D013503:Surgery Department, Hospital / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014600:Utilization Review / Q000379:methods*