Appendix C. Detail on criteria for audit of the use of laparoscopic surgery for colorectal cancer
The National Bowel Cancer Audit Project collects data that enable clinicians to examine the management of patients with colorectal cancer in their hospitals in comparison with others. This national audit includes collection of data on both laparoscopic and non-laparoscopic surgery for colorectal cancer. The audit is commissioned by the Healthcare Commission and run jointly by the Association of Coloproctology of Great Britain and Ireland and the National Clinical Audit Support Programme.
Local clinical audits on the management of colorectal cancer could also include measurement of compliance with accepted clinical guidelines or protocols, or the NICE recommendations for services for people with colorectal cancer.
Possible objectives for an audit
An audit on the surgical treatment of people with colorectal cancer could be carried out to ensure that laparoscopic and laparoscopically assisted resection is used appropriately.
Possible patients to be included in the audit
An audit could be carried out of people with colorectal cancer who undergo laparoscopic and laparoscopically assisted resection or people with colorectal cancer that is considered to be suitable for both laparoscopic and open surgery, who are seen over a suitable time period for audit, for example, 6 months. Both measures that follow could be applied to the first group, and only measure 2 could be applied to the second group.
Measures that could be used as a basis for an audit
The measures that could be used in an audit of laparoscopic surgery for colorectal cancer are as follows.
|
Criterion |
Standard |
Exception |
Definition of terms |
|
1. Laparoscopic colorectal surgery is performed by a surgeon who: a. has completed appropriate training in the technique and b. performs this procedure often enough to maintain competence |
100% of laparoscopic colorectal surgical procedures carried out for people with colorectal cancer |
None |
'Appropriate training' and 'often enough to maintain competence' are as determined by the relevant national professional bodies. Cancer networks and constituent Trusts should ensure that any local laparoscopic colorectal surgical practice meets these criteria as part of their clinical governance arrangements. Clinicians will need to agree locally on how training and frequency of performance of the technique will be documented for audit purposes. |
|
2. The decision as to which procedure is undertaken is made after fully informed discussion between the patient and the surgeon |
100% of people with colorectal cancer that is considered to be suitable for surgery |
None |
The decision includes consideration of the following issues: the suitability of the lesion for laparoscopic resection, the risks and benefits of the two procedures and the experience of the surgeon in both procedures. Clinicians will need to agree locally on how the fully informed discussion with the patient is documented for audit purposes. |
Calculation of compliance
Compliance (%) with each measure described in the table above is calculated as follows.
|
Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed |
x 100 |
|
Number of patients to whom the measure applies |
Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.