PubMed · 10295883
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K Walshe. 1989-10-12. A clear case for audit.. https://pubmed.ncbi.nlm.nih.gov/10295883/
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Measuring outcomes of care is an essential component of clinical governance. This article describes a pragmatic approach to auditing symptom control outcomes in a community specialist palliative care nursing team. Using a palliative care assessment tool, it demonstrates that the team make a positive difference to the patient's experience of most symptoms and a plan for further development of practice is formulated in response to the results of the audit. Unexpected outcomes reveal some of the realities of community specialist palliative care and demonstrate that audit is worthwhile despite some of the pitfalls in this area of practice.
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OBJECTIVE: In the last few years, comparative outcome quality statistics have been one of the key topics for discussion in health care. Comparative audits using overall mortality and morbidity figures can be misleading as they do not take into account variations in urological procedure and patient fitness. The purpose of our study was to compare the crude operative morbidity and mortality rates with the predicted rates using an established scoring system (POSSUM). MATERIALS AND METHODS: To examine these effects, we compared 5 urological operations (transurethral resection of the prostate, transurethral resection of the bladder, radical nephrectomy, suprapubic enucleation of the prostate and radical prostatovesiculectomy) performed by 2 urologists in a prospective study during a 12-month period. POSSUM consists of a simple preoperative physiological score, a postoperative score and defined kinds of complications. RESULTS: One urologist operated on 160 patients, with an operative mortality of 2.5% and morbidity of 31.3%. The other urologist operated on 144 patients, with an operative mortality of 0.7% and morbidity of 9%. At first sight, there appear to be significant differences in operative outcome between the 2 urologists. However, analysis using the POSSUM system predicts a mortality rate of 3.1% for the first urologist and 0.7% for the second urologist (morbidity rates of 35% for the first urologist and 10.4% for the second urologist). Receiver operating curve analysis demonstrated no significant difference between the 2 urologists. CONCLUSION: The present study demonstrates how misleading crude mortality and morbidity figures can be when comparing different urologists. By producing a single assessment of physiological status at the time of operation and of operative severity, POSSUM analysis allows a more realistic comparison between different urologists.