16 - Orthopaedic audit: guidelines and hints

Summary

Introduction

As with all other specialties, orthopaedic and trauma surgeons have been undertaking ‘audit’ in its broadest sense for decades. However, in terms of formalised, structured audit orthopaedics is well behind other specialties. It is self-evident that for any specialty to develop some form of systematic review has to be undertaken. Orthopaedic surgery differs from many specialties in that the true effect of any treatment/management regime and any complications that may arise may not be apparent for many years. Audit in orthopaedics must, therefore, be looked at in two levels – (i) short-term effects and (ii) the eventual outcome whenever that occurs. Any guidelines to implement audit in the specialty have to include review at both levels. Further, in order to be realistic about audit in orthopaedics resource management cannot be ignored. Many orthopaedic operations involve the use of expensive implants. There is a tendency to use the ‘flavour of the month’, which may also be the most costly available at the time. Orthopaedic surgeons must, therefore, act responsibly in using new implants and be able, and willing, to justify their use when challenged.

Like many other specialties orthopaedics has undergone dramatic and irreversible changes in the last 20 years or so.