Blanchard R J, Downs A R
Can J Surg. 1980 May;23(3):278-82.
Practical peer review by means of a clinical audit requires complete documentation, critical assessment and open discussion of difficulties or errors in patient management. The quality of care in a large surgical department was monitored using weekly on-the-ward capture of complications and immediate feedback to involved surgeons. Retrospective peer review of surgical deaths judged the process of patient care in three categories--treatment, investigation and documentation; feedback was also provided. Seven of the 10 surgical services each collected morbidity data for at least 40 weeks in 1976 and 44 weeks in 1977. In 1978, 8 of the 10 services collected data for 50 weeks or more. The number of patients reviewed was 3520 in 1978. Of these, 822 (23%) had complications in 1976, 703 (16%) in 1977 and 918 (17%) in 1978. In 1976, 260 patients died; the quality of care was considered to have been adequate in 67%. In 1977, 278 patients died; in 76% the management was considered adequate. In 1978, 231 patients died; in 68% management was satisfactory. This clinical audit system is suitable for computer programming and can provide a complete and accurate report of the entire spectrum of complications.
通过临床审计进行切实可行的同行评审需要完整的记录、批判性评估以及对患者管理中的困难或错误进行公开讨论。一个大型外科科室的护理质量通过每周在病房收集并发症情况并立即向相关外科医生反馈来进行监测。对手术死亡病例进行回顾性同行评审，将患者护理过程分为治疗、检查和记录三类，并提供反馈。1976年，10个外科服务组中有7个至少收集了40周的发病率数据，1977年收集了44周。1978年，10个服务组中有8个收集了50周及以上的数据。1978年接受评审的患者有3520例。其中，1976年有822例（23%）出现并发症，1977年有703例（16%），1978年有918例（17%）。1976年有260例患者死亡；67%的护理质量被认为是足够的。1977年有278例患者死亡；76%的管理被认为是足够的。1978年有231例患者死亡；68%的管理令人满意。这种临床审计系统适用于计算机编程，能够提供关于整个并发症范围的完整准确报告。
