The Dutch Surgical Colorectal Audit

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Abstract

Introduction

In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch Institute for Clinical Auditing (DICA). This article illustrates key elements of the DSCA and results of three years of auditing.

Methods

Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy; web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects.

Results

In two years, all Dutch hospitals participated in the audit. Case-ascertainment was 92% in 2010 and 95% in 2011. External data verification by comparison with the Netherlands Cancer Registry (NCR) showed high concordance of data items. Within three years, guideline compliance for diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality rates decreased significantly.

Discussion

The success of the DSCA is the result of effective surgical collaboration. The leading role of the ASN in conducting the audit resulted in full participation of all colorectal surgeons in the Netherlands. By integrating the audit into the ASNs' quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative burden; expansion to a multidisciplinary registration; and addition of financial information and patient reported outcomes to the audit data.

Introduction

Several clinical audits have been initiated internationally, acknowledging the importance of reliable and valid quality information in health care. Clinical auditing has been recognised as an important tool for quality assessment and improvement, consequently leading to demonstrable improvements in patient outcome.1, 2, 3, 4 Moreover, clinical audits are increasingly appreciated as a source of information for research on evidence based medicine as they provide ‘real world’ data on patients often not eligible for clinical trials.5 However, the voluntary nature of existing audits may unintentionally lead to participation of mainly dedicated hospitals and underrepresentation of underperforming hospitals. Also, audit data are seldom transparent to other stakeholders involved in health care.

In 2009, the Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) in collaboration with the Dutch Association for Surgical Oncology (NVCO), the Dutch Association for Gastrointestinal Surgery (NVGIC) and the Dutch Colorectal Cancer Group (DCCG). Their main goal was to evaluate and improve quality of care for primary colorectal cancer surgery in the Netherlands.

After one year of registration, participation in the audit had become a national performance indicator. Full participation of Dutch hospitals was realised within two years. Subsequent to this success, the Dutch Institute of Clinical Auditing (DICA) was founded in 2011 with the objective to facilitate and organise the start-up of new nation-wide audits. This article illustrates the introduction of the DSCA in the Netherlands by describing its main features and presenting the results of three years of auditing.

Section snippets

Main features of the DSCA

This section describes the organisational and structural key elements of the DSCA.

Dataset

From 2009 to 2011, 26,511 patients undergoing surgical resection for colorectal carcinoma were registered by all 92 hospitals providing colorectal cancer care in the Netherlands (8 university, 47 teaching and 37 non-teaching hospitals). The national case ascertainment and completeness of the data per patient record was high. Compared with the data collected by the NCR, the DSCA included 80% of all eligible patients in 2009, 92% in 2010, and 95% in 2011. External data verification with the NCR

Discussion

This paper reports the key elements of the Dutch Surgical Colorectal Audit that have been crucial for its success. Quality of care regarding guideline compliance and clinical outcomes for colorectal cancer patients in the Netherlands improved significantly.

Numerous international audit projects leading to substantial improvements in quality of care have preceded the DSCA. Many examples of successful clinical audits have been described in detail.2, 3, 18, 19, 20 Often, the main goal of the audit

Funding

No funding was acquired.

Conflict of interest statement

All authors declare no conflict of interest.

References (21)

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Both authors equally contributed to this manuscript.

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