Skinner P W, Riley D, Thomas E M
Department of Trauma and Orthopaedics, King's College Hospital, Denmark Hill, London.
BMJ. 1988 Nov 12;297(6658):1256-9. doi: 10.1136/bmj.297.6658.1256.
An audit was performed by this department after allegations by the regional health authority of low productivity. It was found that the health authority had underestimated the number of operations performed in 1983 by only 5%, but an inexact classification and grading of operations had led to errors in the performance indicators of 19.8% for the "weighted number of operations" and 34.5% for the "number of major operations per consultant." When the throughput of orthopaedic departments in districts was compared by the regional health authority it was found that such errors in performance indicators had been further compounded by the inconsistent use of population data and incorrect data on medical staffing. Medical practitioners and the health authorities are alerted to this amplification of inaccurate data. Other methods for assessing trauma and orthopaedic surgery are proposed, such as a simplification of the Office of Population Censuses and Surveys classification of surgical operations, grading operations based on time spent in the operating theatre, and provision of computer programs to code for diagnosis and operation when writing discharge summaries.
在地区卫生当局指控生产率低下后，本部门进行了一次审计。结果发现，卫生当局对1983年进行的手术数量低估了仅5%，但手术分类和分级不准确导致“加权手术数量”的绩效指标出现19.8%的误差，“每位顾问的大手术数量”的绩效指标出现34.5%的误差。当地区卫生当局比较各地区骨科部门的工作量时，发现绩效指标中的此类误差因人口数据使用不一致和医疗人员配置数据不正确而进一步加剧。提醒医生和卫生当局注意不准确数据的这种放大情况。还提出了评估创伤和骨科手术的其他方法，例如简化人口普查和调查办公室的外科手术分类，根据手术时间对手术进行分级，以及在撰写出院小结时提供用于诊断和手术编码的计算机程序。
