title: The Dutch surgical colorectal audit.
abstract: BACKGROUND
  In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch Institute for Clinical Auditing (DICA). This article illustrates key elements of the DSCA and results of three years of auditing.
  
  
  METHODS
  Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy; web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects.
  
  
  RESULTS
  In two years, all Dutch hospitals participated in the audit. Case-ascertainment was 92% in 2010 and 95% in 2011. External data verification by comparison with the Netherlands Cancer Registry (NCR) showed high concordance of data items. Within three years, guideline compliance for diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality rates decreased significantly.
  
  
  CONCLUSIONS
  The success of the DSCA is the result of effective surgical collaboration. The leading role of the ASN in conducting the audit resulted in full participation of all colorectal surgeons in the Netherlands. By integrating the audit into the ASNs' quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative burden; expansion to a multidisciplinary registration; and addition of financial information and patient reported outcomes to the audit data.
authors.affiliation: Leiden University Medical Center, Leiden, Department of Surgery, The Netherlands.
authors.forename: N J
authors.initials: NJ
authors.lastname: Van Leersum
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.forename: D
authors.initials: D
authors.lastname: Henneman
authors.forename: N E
authors.initials: NE
authors.lastname: Kolfschoten
authors.forename: G A
authors.initials: GA
authors.lastname: Gooiker
authors.forename: M G
authors.initials: MG
authors.lastname: ten Berge
authors.forename: E H
authors.initials: EH
authors.lastname: Eddes
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: R M
authors.initials: RM
authors.lastname: van Dam
authors.forename: M A
authors.initials: MA
authors.lastname: Elferink
authors.forename: Th M
authors.initials: TM
authors.lastname: Karsten
authors.forename: J H J M
authors.initials: JH
authors.lastname: van Krieken
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.forename: E R
authors.initials: ER
authors.lastname: Manusama
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.forename: W J H J
authors.initials: WJ
authors.lastname: Meijerink
authors.forename: Th
authors.initials: T
authors.lastname: Wiggers
authors.forename: E
authors.initials: E
authors.lastname: van der Harst
authors.forename: J W T
authors.initials: JW
authors.lastname: Dekker
authors.forename: D
authors.initials: D
authors.lastname: Boerma
mesh_terms: D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D003107:Colorectal Surgery; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011785:Quality Assurance, Health Care; D012042:Registries
keywords: Clinical audit; Colorectal neoplasms; Colorectal surgery; Quality assurance; Quality improvement