Problem-oriented surgical audit in the community hospital. A concept in evolution.

A system of surgical audit based on identification and solution of surgical problems is described. The system relies initially on universal review of patient records on a monthly basis by surgeons in the involved institution. Evolution of the system to one which the records of certain patients can be excluded from review by physicians is seen as practical, if careful definition of such records is maintained. Emphasis on the goal of meaningful quality of care assessment is critial. Utilizing this system, surgeons in Stamford, Connecticut, have found significant deficiencies in diagnostic, therapeutic, or both of these aspects of patient care in 5 per cent of records reviewed. Ninety-five per cent of patients were judged to have had no important inadequacies in their surgical care, based on evidence in their medical records. Attempts to evaluate surgeons' behavioral changes, when deficiencies in their patients' care have been demonstrated, are being pursued actively.