tailieunhanh - POSSUM: a scoring system for surgical audit

A strategic plan helps guide the development of the internal audit function. The plan is more than a point-in-time risk assessment. It formally defines the value proposition of the new function, the customers it serves and the value it will create now and into the future. It outlines operational tactics to achieve key objectives as well as functional management responsibilities. The plan also addresses funding and human resource needs both initially and over a three-to-five year horizon. Key assumptions and benchmarks comparing the plan against third-party data are generally included. The plan may also consider the costs and benefits of using differing approaches to achieve the desired. | Br. J. Surg. 1991 Vol. 78 March 356-360 POSSUM a scoring system for surgical audit G. p. Copeland D. Jones and M. Walters Department of Surgery Broadgreen Hospital Thomas Drive Liverpool L14 3LB UK Correspondence to Mr G. p. Copeland POSSUM a Physiological and Operative Severity Score for the enumeration of Mortality and morbidity is described. This system has been devised from both a retrospective and prospective analysis and the present paper attempts to validate it prospectively. Logistic regression analysis yielded statistically significant equations for both mortality and morbidity P 0-00 Ỉ . When displayed graphically zones of increasing morbidity and mortality rates could be defined which could be of value in surgical audit. The scoring system produced assessments for morbidity and mortality rates which did not significantly differ from observed rates. While data regarding the access of patients to care and outcome presented as overall mortality and morbidity rates are relatively easy to derive quality of care has proved a more elusive determinant. In most hospitals quality of care is assessed by discussion of individual cases or by review of series of patients undergoing particular types of surgical procedure. Comparisons between different surgeons units hospitals and regions are bedevilled by differences in patient presentation general fitness of the local populace and the nature of the surgery undertaken. The Royal College of Surgeons of England has defined audit as the systematic appraisal of the implementation and outcome of any process in the context of prescribed targets and standards 1. The difficulty in this definition rests in the interpretation of prescribed targets and standards and it infers that outcome for individuals and series of patients can be predicted. In this context morbidity is probably as important as mortality certainly when discussing quality of care. Perhaps of parallel importance in audit is the discussion of individuals in whom

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