Blurred vision: problems of auditing elective surgery, as seen in an audit of lens extraction for cataract.

Failure to limit the topic can complicate the audit process by producing too many variations and data not relevant to all patients in the study. Because assessment of the need for lens extraction is subjective, formulating justification criteria is difficult; objective evidence that the patient actually needed the surgery may be lacking. Outpatient records showing the results of surgery, ie, whether a patient's vision has been improved, are usually not available to the audit committee. Consequently, the patient's true outcome after surgery cannot be properly evaluated unless specific follow-up criteria are developed and outpatient records are available to the audit committee. An ideal audit of lens extraction for cataract might combine outpatient records noting results of preoperative workup, the hospital chart, and the clinic record of postoperative care and results. Only with all pertinent information can a complete assessment of the quality of care be made. Because audits rely heavily on the use of data from inpatient records, other methodologies may be more appropriate for review of elective procedures. Audit committees should consider this possibility and beware.