Peroperative anaesthetic audit

Abstract

The need for audit of operating theatre work is clear, both from an ethical and a medicolegal standpoint--'in-house quality control is an important aspect of clinical practice' (Lunn and Devlin, 1987). The problem is to know what to record, and how to record it so that it will be both acceptable and worthwhile to working anaesthetists. The first report of the audit committee of the College of Anaesthetists (November 1989) suggested the use of logbooks to make a personal record for all anaesthetists, together with a record of departmental theatre service load, work in other areas such as the intensive care unit, morbidity and mortality audit, a critical incident register and education audit. We have been recording departmental and individual theatre service load for three years. At first, we attempted to record every fact about the anaesthetic to form a complete anaesthetic record so that no data would be lost. There are many variations on this theme: Cardiff (Lunn and Vickers, 1982), Glasgow (Todd et al, 1983), Harvard (McPeek, 1980) and others have collected large databases and distilled essential information from them. For example, at Cardiff (Farrow et al, 1984) and Cleveland (Schneider et al, 1979) it has been shown how one could begin to predict anaesthetic risk factors and hospital morbidity. This sort of work, however, requires substantial resources of manpower and funds which are seldom available. Moreover, when these data were considered more closely, the vast majority was of little use to a district hospital, where it is not generally necessary to collect information about drug and disease type during anaesthesia since this information is already available as part of the patient administration system or from the pharmacy computer. Computerizing the anaesthetic record was not part of our task. We had thus to define our requirement more clearly. It was to develop a system that could be used by an anaesthetic department to provide the peroperative data needed for audit and management on a daily routine basis. Information should be derived that would provide answers to the sorts of questions being asked by the College Visitors when reviewing a department, or by managers looking at working patterns. There should be in addition some record of the complications arising during anaesthesia. The system should use a standard software package, running on standard equipment that can be bought 'off the shelf', so that both can be used by the department for other purposes during the time that it is not processing data,