Orthopaedic audit: a comprehensive system for in-patients.

Problem Oriented Summary, Audit, Discharge (POSAD) is presented as a system which permits auditing of in-patient admissions. It is prospective, comprehensive, simple to operate and generates an immediate discharge summary. it has replaced the conventional hospital discharge summary and therefore does not increase secretarial or medical workload. It can be run either as a paper-based system or computerized. The work profile and quality control information that has resulted from the 1982 auditing of the Hollywood Orthopaedic Service is presented. This service involves eight consultant orthopaedic staff who dealt with 2,322 hospital patient admissions in that year. Auditing/peer review has shown up wide variations in surgical behaviour and the workload undertaken by individuals. The information that has been produced has enabled the surgeons of this service to put into effect three significant innovations. These are: (a) Regular analysis of complications. (b) Rank ordering (comparison) of individual surgeons. (c) Ready access to current statistics.