Linked Life Data

8017801

Source:http://linkedlifedata.com/resource/pubmed/id/8017801

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
1 Suppl
pubmed:dateCreated
1994-7-27
pubmed:abstractText
The quality of medical record keeping is being subjected to increasingly close scrutiny. The 1992 report of the National Confidential Enquiry into Perioperative Deaths (NCEPOD) noted a considerable variation in the quality of operation notes submitted by all contributing surgical specialties. This study has audited the quality of 264 general surgical operation notes written by 10 consultants and 16 trainees in two district general hospitals (DGH). Postoperative instructions were absent in nearly two-thirds of operation notes and serial numbers of prostheses were rarely recorded. On almost every criterion trainees scored higher than consultants and emergency operation notes scored better than elective notes. About 70 per cent of notes written by consultants were illegible or the procedure could not be understood from the description given, by the nurse or junior doctor collecting the data. Until word processor databases become more widespread in operating theatres, it is suggested that a specifically designed proforma be used, with prescribed headings to act as aides-mémoire for the surgeon.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
IM
pubmed:status
MEDLINE
pubmed:month
Jan
pubmed:issn
0035-8843
pubmed:author
pubmed:issnType
Print
pubmed:volume
76
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
8-10
pubmed:dateRevised
2007-11-15
pubmed:meshHeading
pubmed:year
1994
pubmed:articleTitle
An audit of the quality of operation notes in two district general hospitals. Are we following Royal College guidelines?
pubmed:affiliation
Dept of Surgery, Northampton General Hospital, Northampton.
pubmed:publicationType
Journal Article