Audit of surgical audit.

A clinical audit, run by surgeons with modest clerical assistance, has been incorporated into the routine clinical practice of all hospitals in a large health authority. Data on operations and deaths are integrated into routine clinical recording, and feedback is by annual report containing statistical analyses and critical commentaries and by discussions with colleagues. The results of the first five years show statistically significant falls in the number of reoperations for intra-abdominal complications, retained gallstones, arterial grafts, and amputations and in operative mortality following surgery for benign biliary and pancreatic disease, resection of large bowel for benign disease, operations on aortic aneurysms, and arterial grafts except for aneurysms. Although the audit was designed originally for monitoring and improving quality of care, other uses include monitoring of increasing specialisation and changes in clinical practice, planning surgical services and postgraduate training, and showing the effects of changes in the availability of resources.