Indicators of quality in district hospital surgery

How can you know that surgical care in a hospital is good? What should a visitor look for when he goes round your hospital and what questions should he ask? Here are a few suggestions.

INDICATORS OF QUALITY IN SURGERY The hospital has a plan as to which day of the week non- urgent operations are done, and when clinics are held.

Ward rounds are held daily.

Each patient has a plan in his notes saying what should happen to him and when[md]when a cast should come off, when traction should be taken down, or a burn should be grafted, etc. There are accurate notes in enough detail to enable another doctor to take over.

The staff wash their hands after examining a potentially infected patient, before examining the next one. Not to do so, especially after examining an infected wound, is the height of bad practice[md]presuming, of course, that the ward has water, which, alas, some do not. Patients are washed thoroughly with soap and water before surgery[md]especially the operation site.

How often do clean operations in your hospital become infected? (2.10)

How many skin grafts do you do, and how many of them take? (57.1)

How much knee movement do your patients have when you discharge them from hospital after you have treated their broken femurs? (78.3)

Are all patients whose fractures have been put in plaster, told to to return immediately if they get pain? (70.4)

Are there any instruments or equipment, which were broken more than a month ago, which no attempt has yet been made to replace or repair?

Is some provision is made to provide terminal care for cancer patients? (33.1)

Do you know your mortality rate for the more common operations?