Audit at Jeddah Hospital on Cholecystectomy - Case Study Example

Audit at Jeddah Hospital on Cholecystectomy Name University Contents 1.0 Introduction 2 2.0 Background and Literature Review 3 2.1 Jeddah Hospital 3 2.2 Gallstones 4 2.3 Types of Cholecystectomy 5 2.3 Benefits 6 2.4 Information about Use of Audits 6 3.0 Rationale 6 4.0 Objectives of Study 7 5.0 Criteria of Audit 7 6.0 Scope and Methodology 8 6.1 Findings 9 6.2 Cost of nursing in the ward 9 6.3 Pathology and imaging cost 10 6.4 Operation times 10 6.5 Use of CT Scans and Dedicated Teams 11 6.6 24 hour turnaround Completion rate in planned admissions 11 6.7 Discussion 12 6.8 Recommendations 13 References 14 7.0 Appendix 15 1.0 Introduction Quality of service in a healthcare facility is imperative as it guarantee the adherence of safety measures pertaining the health of the patient. In this regard, it is important that quality of laparoscopic Cholecystectomy is gauged with respect to the set guidelines. Although laparoscopic Cholecystectomy is considered as a safe practice in healthcare centers with adequate facilities, its associated feasibility and quality of service offered has not received adequate review. Quality assurance, health authorities and surgeons working in developed countries may be subject to subjecting patients to low quality services, as such affecting the patient’s experience at the healthcare facilities. In a majority of healthcare facilities, laparoscopic Cholecystectomy is considered as a gold standard; essential for treating gall related problems. The introduction of these techniques has imposed the evolution of the practice, as well as, new interest in the field. Yet, as the practice is received by patients, its safety and quality is imperative in realizing the proffered procedures. 2.0 Background and Literature Review 2.1 Jeddah Hospital Since the beginning of the hospital, the staff has championed in healthcare services given the patient’s experience. Considered as a standard and proffered healthcare facility, it has effectively offered various practices ranging from medical, diagnostics and surgical specialties. The facility aims to provide improved and quality of service to its patients, given its recent advancement in laparoscopic Cholecystectomy. The healthcare facility holds about 300 staff member of which 20, are dedicated surgeons in this profession. Tentatively, the hospital has aggressively excelled in its field of operation. Some of the vital information of the hospital are shown below: Indicators. Total Bed number. 800 A&E. 50000 Average patient survival (per day). 6 Surgical operations 9000 Kidney transplantation 90 Liver transplantation 80 Heart transplantation 30 Bone marrow transplantation 250 In a nutshell, Cholecystectomy is a surgery of choice of symptomatic gall-stones, since it effectively removes organs that result to the formation of gallstones (Miller, 2013). As such, this is a surgery that pertain the removal of the gall bladder. The gall bladder is a small sac located in the right side of the human upper abdomen (Miller, 2013). It is linked to the bile ducts which originates from the liver and is tasked with carrying bile into the intestine. The production of bile is fundamental for digestion of food. Nonetheless, gall bladder is not essential in maintaining human health hence after its removal, bile flows into the liver directly. 2.2 Gallstones More often than not the gall bladder may be subject for removal, upon residual discovery in the bile. Simply put, gallstones are minute solid substance, resembling debris in the bile. Accordingly, stones may be found in the duct that leads from the gall bladder. Gallstones are found in various sizes, color and shapes, but is fundamentally made up of excess cholesterol (Casillas, 2008). They are associated with diseased gallbladders. Stones may result to tremendous swelling of the affected organ, resulting to detrimental health of affected persons. Stones are very common, and may affect two of every 11 persons (Casillas, 2008). They are majorly experienced among the elderly persons, women associated with the use of constructive pills, obesity and pregnancies. Over time they gradually increase in size but the small stones are major causes of pain, in this regard. 2.3 Types of Cholecystectomy Although they can be treated, Cholecystectomy surgery may be advised in certain cases. The gallbladder may surgically form after substantial swelling in the gallbladder. This operation is imperative in relieving pain during gall bladder swelling. There are two ways through which this surgery may be achieved. i. Laparoscopic Cholecystectomy Otherwise known as keyhole “Surgery”, laparoscopy facilitates the inspection of the abdomen’s interior - without making major incisions on the abdomen. The surgeon makes an incision of about 2 to 3 cm long at the navel of the abdomen (Miller, 2013). After the small incision at the navel, the surgeon inserts the laparoscope machine; a long, narrow telescope that is attached to a video camera. Thereafter, the abdomen is inflated by using carbon dioxide gas; a harmless gas that creates room for the operation. Two cuts of about 0.5 to 1 cm in size are made just below the rib margin. Consequently, a fourth incision is made at the upper abdomen, next to the breastbone; used for the insertion of the instruments like forceps and scissors. Surgical clips are used in securing these arteries and duct in preventing leakage of excessive bleeding. Accordingly, the gallbladder can be removed through one of the incisions. In most cases the surgery last about 30- 90 minutes, with respect to the size of inflammation and difficulty of operation. ii. Open Gall Bladder Surgery This surgery is achieved through making a big and open surgery just below the rib, at the right side of the abdomen. A large incision is made, and through direct site, the doctor operates to remove the inflated gall bladder (Teoh, 2007). 2.3 Benefits There are many benefits realized through the laparoscopic process. Most of the patients have significantly reduced postoperative pain (Teoh, 2007). Consequently, they heal faster as opposed to open surgery. Thirdly, the patient is able to resume to his normal activities faster as opposed to the traditional surgery. 2.4 Information about Use of Audits In a nutshell, audit and feedback is a cumulative summary in any clinical performance over a given duration that offers provision of information to healthcare professional. Essentially, the information allows the healthcare professionals to adjust on their performance (Haynes, 2008). Simply put, healthcare practitioners receive feedback on their performance through a reflection of the derived data. Despite the intuitive nature of the audit, it is imperative to gauge their performance on the consistency of acceptable levels (Powell, 2008). The healthcare sector has been a sensitive aspect as it governs ways through which human treatment can be achieved. In this regard, the inception of audit on the same has championed the quality of healthcare services offered at various institutions. Information obtained from audits is indispensable in improving the quality of service offered (Haynes, 2008). Thus, it is important that audits are sufficiently conducted and information obtained be used effectively throughout the management practice (Kodner, 2009). In most cases feedback can be presented from a variety of ways ranging from recipients to content. 3.0 Rationale Nursing practitioners, together with surgeons play an essential role in sustaining quality and safe procedures for the patients. In this regards, an audit was conducted on thirty patients at Jeddah Hospital on 2007 in ascertaining the quality of service offered. Consequently, findings and probable recommendation were discussed in this regard. 4.0 Objectives of Study The aim of this study is to offer a retrospect audit on the quality of Cholecystectomy surgery, done during the operation and the recovery process. Essentially, the analysis is imperative for the clinical experts and to better understand the variations in the clinical practice at Jeddah Hospital. Tentatively, an analysis on the extent to which the variations affects the clinical quality outcomes is ultimately conducted. 5.0 Criteria of Audit The following criterion of audit was used; Figure 1 Criterion No Indicator Indicator Availability Expected rate Expectation 1 Safety and outcome indicators 1 (a) Was the risk adjustment less than 28 days? Data provided by Hospital records 100 % None 1 (b) Was the unplanned return visits high ? Indicator not collected with consistency 100 % None 1 (c) Was the patient infected after surgery? Data provided by Hospital records 100 % None 1 (d) Was blood transfusion rate appropriately followed? Read More