Introduction Colorectal and stoma care nurses have been auditing their specialist services for years, but have contributed less frequently to colorectal surgical service-wide audit measuring clinical outcomes relating to surgical as well as nursing care. Nurse-led follow-up provides the ideal platform to measure key indicators of quality care and identify areas for both service improvement and future research activity.
Method A nurse-led follow-up clinic at 30 days following patient discharge was used to audit 142 consecutive patients undergoing elective (n = 98) or emergency (n = 44) colorectal resection over a three month period. Audit data were recorded at two time-points, discharge from hospital and at clinic, with audit templates developed using validated tools designed to measure general post-operative morbidity1,2and modified to include a focus on colorectal surgery-specific complications. Audit templates were tested during two clinics prior to full data collection to ensure they included all required variables.
Results A wide range of anticipated and unanticipated findings were identified relating to both inpatient and early post-discharge morbidity. Findings were presented to the whole colorectal team, including upper GI and colorectal surgeons and their teams, specialist nurses, theatre-based and ward-based nursing staff. Areas of clinical practice identified by the audit as requiring improvement were identified and discussed, with immediate changes to surgical practice agreed by the whole team. Nurse-led follow-up for all colorectal patients was established as a potential goal for future service improvement.
Conclusion This nurse-led audit enabled the whole colorectal team to scrutinise their clinical practice by comprehensively examining patient outcomes at two time-points following colorectal resection. Nurse-led follow-up using an auditable documentation template facilitates the recognition and reporting of a wide range of post-operative complications and provides valuable support for patients, particularly those who do not have routine access to specialist nursing services.
Disclosure of interest None Declared.
Dindo D, et al. Classification of Surgical Complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213
Grocott MPW, et al. The Postoperative Morbidity Survey was validated and used to describe morbidity after pelvic surgery. J Clin Epidemiol. 2007;60:919–928