FREE SurgicalPerformance Audit in Obstetrics and Gynaecology

Tagged Audit, SurgicalPerformance; Posted 12 years ago

If you think about it for a second it is pretty clear: You cannot improve outcomes that you don’t measure.

I got in contact with the idea of “audit” when I read Atul Gawande’s book “Better”. This is a great book for everybody who cares. Atul Gawande is a general surgeon living in Boston and a medical writer (“Complications”, “The Checklist Manifesto”). He also writes for the New Yorker magazine. 

In “Better”, amongst other topics, he describes how survival of patients diagnosed with cystic fibrosis steadily improved over years and decades in the US. The major game changer was not a new technology, intervention or a new drug. The major game changer was information and feedback about treatment outcomes that became available to doctors who treated cystic fibrosis patients.

Individual centres recorded and made available their information on treatment outcomes to their peers. Centres that achieved below average outcomes learned that they actually underachieved, which often they found hard to believe and unsettled them. They really did not know this until then. Now they were able to review their practices, learn a few tricks and from then onwards outcomes improved naturally.

In our field, it is very similar. We practice what we learned as a trainee years ago without much reflection. Yes, we do attend morbidity and mortality conferences but there is documented evidence that sometimes we are hesitant to speak freely in the presence of colleagues because we are concerned that we could look stupid, fallible and weak. Naturally, there is no feedback about what we do and how we do once we finish training. We can be lucky if someone has the guts to make us aware of things that could be done a lot better. In our country we are usually very nice and polite to each other, which makes negative feedback even more difficult.

I started SurgicalPerformance because I was genuinely interested how well I do; how often do I achieve what I want to achieve and how often do I not score. In times when I have surgical complications, I find audit very consoling. Those times of complications are emotionally low times for me. My family, my friends and colleagues put up with me in those bad times and get me back on track. SurgicalPerformance puts it all in a frame for me. Yes, a complication did happen, but I can see that I also treated a large number of patients (the vast majority actually) who did well, had no postoperative issues and left hospital after one or two days.

I also started SurgicalPerformance because it lets me use modern technology for my advantage to compare myself with others. Confidentiality is guaranteed. It is as safe as Internet banking. My peers use it and provide data for comparison. SurgicalPerformance demonstrates to me that complications happen to all of us.

SurgicalPerformance is a learning tool to enhance surgeons’ lives. Confidentiality is critical. Previously, I was offered to sell a license of SurgicalPerformance to a surgical society that was planning to monitor their members: “We weed out the bad ones”. I could have made great money but declined. Surgical learning does not work through the stick. If we use the stick, we all learn how to negotiate around or betray the stick. I deeply believe that only the carrot works. SurgicalPerformance is independent and does not share sensitive data with third parties, such as government bodies, College or professional societies.

So, what do I personally like about audit?

• It gives me a sense of control (to the extent that it might prevent me from litigation)
• It makes me a better surgeon
• It gives me a buddy; tells me truthfully where I stand
• It makes me belong to a group of like minded surgeons
• I claim loads of PR&CRM points and I don’t need to attend a conference and set pre- and post- tests that I don’t want to take.
• My secretary can enter the admin part into the database
• I like that some 50 O&G specialists take part in SurgicalPerformance audit right now and share their data for each others and for patients’ benefits.

Why do I think audit worked in my practice?

When I document my treatment successes and failures, my practice will put a focus on quality outcomes. What follows are actions consistent with quality improvements. I might ask for a second opinion in regards to pre-surgery diagnostic investigations; I might review the indication for surgery or I might even discuss the indication with a colleague; I might decline to do an operation in a small out-of-town hospital; I might introduce my own surgical checklist because the “official” checklist from my hospital is useless; I might …. do a lot of different things that help me achieve a great outcome. Once I get the focus right, the right actions will follow.

For clinical audit, measuring the outcomes that we achieve as surgeons, obstetricians, gynaecologists have shown massive improvements. In colorectal surgery audit resulted in a reduction of severe complication rates by 50%. In vascular surgery, the incidence of stroke reduced massively after audit was introduced; lots more references can be given for a number of different surgical specialties to prove improved outcomes associated with clinical audit.

The LITE version of SurgicalPerformance has been made free this week. Users can enter their data, check their outcomes and earn PR&CRM points through RANZCOG. RANZCOG allows one PR&CRM point per hour of audit. If we assume that entering one surgical case into SurgicalPerformance takes 5 to 10 minutes, I earn 1 PR&CRM point by entering 6 cases. We can accumulate more than the required CPD points in the PR&CRM category alone. SurgicalPerformance makes it too easy!

A PREMIUM version is $25 per months and will give users comparative data for benchmarking. In essence, your data will be presented in a comparison with averaged data from your peers to see where you stand. A Premium subscription can be cancelled monthly.

Is Ethics application required? No ethics application and no patient consent are required. Audit is part of clinical routine and not research. If data that have been captured through audit are processed and prepared for a publication, a low risk ethics application must be made to cover data analysis and reporting of outcomes.

SurgicalPerformance is not for everyone; it is for specialists and trainees who want to know.   

Next week we will discuss how Australian O&Gs cope with complications.