PLAUDIT
An advanced Surgical Audit tool that extracts information from multiple sources
Ensuring the most complete Audit without a huge administrative burden
Why do surgeons Audit?
Classically, Surgical Audit has been a keystone of surgical quality assurance. It is a voluntary peer review process, analysing care volumes with complication ratios and severity, searching for outliers or undesirable trends. If anomalies or concerns are identified, these can be followed up to ensure that quality is maintained.
At the same time, most healthcare systems report that volume and complexity of care continues to increase every year. There are multiple drivers including aging population in many Western nations, but also ever-increasing care modalities and options that add complexity and workload. Surgeons are confronted by the need to minimize hospital stays to increase throughput of increasingly sophisticated interventions, while still maintaining quality.
More Data, Less Dependency
The Plaudit Surgical Audit tool provides a first class Audit resource utilizing existing data flows, with as few moving parts and dependencies as possible in the interests of reliability. Plaudit overcomes barriers to participation via 3 mechanisms:
- If surgeons dictate complication headers as part of any document, the Plaudit Artificial Intelligence engine can automatically identify and extract the complication for Audit.
- If surgeons need to extract extra data items for specialty Audit participation, registering those elements in Plaudit will cause the AI to extract those too, or even to assemble the whole information package to be submitted for audit.
- Plaudit links into the hospital's clinical coding system to extract the facility's best event data, as well as complications identified by the coders.
Running the Audit
As the Audit meeting date draws closer, an Audit file for each team or consultant is extracted. An Audit file contains all the material needed for a satisfying Audit meeting. With one file per meeting, teams can edit their Audit File, or email it, or even store it on a shared hard drive because it is heavily encrypted and can only be opened by the facility and department that created it.
The Audit file
As noted, an Audit file is a highly encrypted stand-alone file that does not need a database. The file is encrypted by a salted AES-256 CBC mechanism that exceeds the most stringent encryption standards in any jurisdiction, using special keys that are unique for each facility and department, so that a Plaudit file can only ever be opened again by the department that created it.
The Audit file includes:
- Complications identified by the coders,
- Complications dictated by the surgeon in the Audit period if the Plaudit AI is in use,
- Event/Admission data for trend analysis and volume review.
To "run" their Audit, the responsible clinician reviews the contained complications and decides which are to be included in the report. These can be sequenced or gathered into categories. Annotations can be added, as can additional complications.
Customization
The Audit File is highly customizable using the proven Plato Generator engine. Departments can set up their own teams and categories of interest, including ethnic, and choose which options they want calculated for Audit. Once the definition is complete, from that point onwards it only needs a date range to create all the Audit files with all the content the Department wants to review.
Ethnicity
While ethnicity has not always formed part of a Surgical Audit, increasingly diverse populations can create new complication risks or evaluation paths. The Plaudit ethnicity follows common national standards like prioritized or major ethnicity so that departments review the same data as administrators and national funders.
This is an example of an Orthopedic Audit defined in the Plaudit Generator. Once your Audit is defined, it can be run by simply specifying a date range.
Complexity and Risk Scores
If the information is available, Plaudit can include standard surgical risk scores like P-POSSUM to correlate complications to mortality and morbidity risk.
Alternatively, administrative scores like ECCS (Episode Clinical Complexity Score) can be calculated by Plaudit itself. ECCS is a complexity score maintained by the Australian government and licensed to many other nations. ECCS correlates millions of combinations of diagnoses and comorbidities to yield an overall admission "complexity" that correlates well to levels of care/morbidity. When you consider that P-POSSUM converts physiological values and surgical assessments into an overall risk, often those values are proxies for underlying diagnoses that have a more direct relationship with risk. As an example, deranged hematology carries a risk, but the gastric ulceration causing it has a better link to risk, which is what ECCS calculates.
Note: the intellectual property underling ECCS is closely held by the Australian IHACPA and may only be used in countries that have an IHACPA country license. ECCS will not be available in other jurisdictions, though the older PCCL score may be. Plato personnel can advise further.)
Ask for a demonstration!
The best way to see how Plaudit could work for you, is to ask for a demonstration including Audit definitions and management of the Audit file.