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EDITORIALS: Peter J E Holt, Jan D Poloniecki, and Matt M Thompson How to improve surgical outcomes BMJ 2008; 336: 900-901 [Full text]

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Scepticsm regarding claims for low mortality/morbidity for self reported audits

Mohan Adiseshiah   (7 May 2008)

Scepticsm regarding claims for low mortality/morbidity for self reported audits 7 May 2008
Mohan Adiseshiah, Consultant Vascular/Endovascular Surgeon University College Hospitql, NW1 2BU Send response to journal: Re: Scepticsm regarding claims for low mortality/morbidity for self reported audits	Dear Sir I was interested in the advice given in your editorial “How to Improve Surgical Outcomes” in the BMJ 26th April. As recommended by the authors, locally conducted audits are invaluable and indeed essential for good clinical practice. The problem here is that of self-reporting. However, not from any intention to deceive, it can be possible to misinterpret and miss the significance of mortality and morbidity results reported in-house. Any voluntary registry or audit is suspect of incompleteness of the data. The best safeguard against this is to invite an external auditor to review the findings. In this sense nationally collected data for a particular institution such as the Dr Forster database, and indeed any HESS data, provide an independent means of validating the in house data collection. It would be useful if when large institutions self- report large numbers of cases, claiming lower mortality/morbidity as a result of volume, that this is validated by an external audit on a regular basis. Yours faithfully M Adiseshiah MA MS FRCS FRCP CONSULTANT VASCULAR/ENDOVASCULAR SURGEON Competing interests: None declared