Blair R L, McKerrow W S, Carter N W, Fenton A
Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, UK.
J Laryngol Otol Suppl. 1996;20:1-25.
Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication-Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department. Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation. Data were obtained from a total of 9,773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4,309 were outpatients only and 3,385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire. The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some are ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation. Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed. Recommendations regarding changes in tonsillectomy practice are given.
地区专业协会为开展医学审计提供了一种宝贵的机制。苏格兰耳鼻喉科学会审计小组委员会对喉癌进行审计的经验促使我们在苏格兰对扁桃体切除术的实施情况进行一次规模更大的审计。尽管在过去10年里扁桃体切除术的实施数量有所下降，但它们仍占耳鼻喉科医生所做所有手术的约20%，因此是资源的主要消耗项目（个人交流——信息服务局、信息与统计司。苏格兰国民保健服务体系，管理执行局，爱丁堡）。苏格兰扁桃体切除术审计旨在界定当前的做法，审查手术指征，并就可能需要的做法改进提出建议，以优化患者护理和资源利用。资金由苏格兰家庭与卫生部的临床资源与审计小组（CRAG）提供。1992年2月至1993年1月期间收集了关于当前做法的数据。所有参与医院的医疗、行政和秘书人员填写了调查表，由一名审计秘书收集并转交给相关的数据收集中心。然后将数据输入一个专门设计的数据库，再转发给位于邓迪的审计协调员进行整理。手术后6个月和12个月，向所有住院患者发送了一份问卷，以获取有关手术疗效的数据。总共从9773名患者那里获得了数据。其中2079名患者既作为门诊患者又作为住院患者接受了诊治，4309名仅为门诊患者，3385名仅为住院患者。4101名患者至少返回了一份随访问卷。审计的主题包括转诊来源和原因、手术指征、参与的工作人员级别、手术类型和住院时间。与先前的研究结果一致（英国皇家文书局，1989年），不同卫生委员会的扁桃体切除术实施率存在差异。尽管高地地区的转诊率和手术率最高，但在所有其他地区，转诊率和手术率并不相关。复发性扁桃体炎是决定手术的最常见主要原因，尽管不同卫生委员会在包括阻塞性症状在内的其他指征方面存在差异。大多数患者有症状两到三年，尽管有些患者在被列入扁桃体切除手术名单之前已经受影响40年。一些耳鼻喉科服务以顾问为主，而其他服务涉及更多初级工作人员。参与的工作人员级别似乎并未影响门诊部（OPD）做出的决定或手术结果。返回问卷的患者中有98%对进行了手术感到高兴。文中给出了关于扁桃体切除术做法改变的建议。
