Criteria audits in health care - Essay Example

? The implementation of Criteria Audits in healthcare provides an integral part of the clinical governance to ensure that the patients get the correct and best possible care from the attending physician and the Hospital. Clinical governance is defined as the process by which various health service organizations are monitoring and ensuring improvement of the quality of their services in such for the benefit of patients. The most critical areas of criteria audit implementation are the pre and post surgery care. This will estimate the prognosis of the surgeries, the true necessity of the surgery and the staffing functions related to maintenance and collection of appropriate health records pertaining to the surgical care process. (Abdelhak et al., 2001) .The criteria audit in this paper is based on cholecystectomy which will throw a light on the actions and recommendations that are to be accepted to improve upon from the present status of health care provisions. Background The study includes the Curtin Hospital which is one of the important and busy hospitals in terms of handling a high volume of trauma care patients. It is a Government run public hospital and the patient profile is widespread belonging to diverse economical backgrounds. Cholecystectomy: Overview. The term ‘Cholecystectomy’ is defined as the surgical removal of the gall bladder .It is done when a condition called cholelithiasis or commonly called ‘Gall stones” occurs and cholecystectomy aims to remove these stones only (Kapoor, 2007). This procedure is one of the commonest operations carried out all across the world because these stones will not only cause lower abdominal pain and impaired fat digestion but also predispose the patient to a gall bladder infection often leading to septicemia. The procedure is performed by the modern laparoscopic cholecystectomy, where a small incision is done in the abdomen to perform the surgical removal, thus the chances of infection are minimized and the patient can be discharged from the hospital within 2-3 days. Another method is the traditional open cholecystectomy where the major portion of the abdomen is held open, to have a proper view of the affected area, but the chance of post operative infection is higher. The patient remains ambulatory till few days compared to the laparoscopic method. (Kapoor, 2007). Medications may be also administered to dissolve the gall stones in the question (Onders & Hallowell, 2005). The major complication of cholecystectomy is the damage to the common bile duct, which carries out the discharge of hepatic bile and gall bladder bile to the duodenum, for fat digestion. This complication is pointed out as a criteria of medical malpractice (Onders & Hallowell, 2005). Importance Of Criteria Audit in Cholecystectomy Criteria audits will increase accountabilities of the surgeons on a given surgical procedure and they also should have a clear cut justification for the surgical intervention planned for the management of the patient (Hay et al., 2006). The usage of criteria audits is in place in the administration of Australia since 1980 (Collopy et al., 1981) and has been used in other countries (Bailey et al., 2010). The Rationale Of the Audit This audit will evaluate the situation of cholecystectomy surgeries in the hospital as per the compliance of the recommendations based on the Royal Australian College of Surgeons Board. Objectives of The Study a. Determine whether the cholecystectomy performed in the Hospital was justified 100% of the time or occasions? b. Whether the safety of the procedure is ensured which means is there a 0% fatality rate? c. Whether maximized clinical interventions and competence has been applied for the procedure? d. Whether there is prevalence of post operative surgical infections and if so to what extent? Methodology The criteria audit will be applied on 80 randomly selected patients who have undergone cholecystectomy in the hospital during 2008 will be selected and the audit will be conducted adhering to the Guidelines of the Health Services (Quality Improvement) Act 1994. To ensure confidentiality all the identifying marks of the patient will be removed from the study. Inclusion Criteria Patients diagnosed with gall stones and have been selected for planned surgery based on the USG reports. Males and Females. Emergency Department Recommendations. Both Acute and Chronic conditions were selected. Exclusion Criteria Sudden decision of cholecystectomy. Coexisting other surgeries like removal of uterine myoma, hernia. The patient information was collected from the six sources which are: anesthetic notes, the discharge and admission summary, emergency department feedbacks, inpatient progression notes, outpatient department feedback which conducts follow up of cholecystectomy patients and other referral letters placed before the hospital authorities . Deviations from 100% may indicate medical malpractice which will be reconfirmed by statistical significance. Criteria’s to be assessed in the audit RACS has recommended a 11point criteria as discussed in results below. Results & Findings(Q1-Q5) Criterion Do the signs, symptoms and investigations pre-cholecystectomy justify the surgery? Was the pathology report positive? Was there surgical exploration of the common bile duct? If so, is there evidence of disease of the common bile duct? Is the admission free of unplanned additional surgery? Has the patient been given antibiotic prophylaxis in accordance to the given protocol? Expected Numbers for compliance (100%) 100 100 100 100 100 100 Expected Numbers for compliance (80/80) 80 80 80 80 80 80 Matching Clinically(%) 80/80 (100%) 68/80 (85%) 44/80 (55%) 43/80 (54%) 79/80 (98.75%) 58/80 (72.5%) Statistical Significance of Deviations p>0.05 p Read More