Lothian Surgical Audit: a 15-year experience of improvement in surgical practice through regional computerised audit

For the past 15 years, general surgeons in Lothian, UK, have done a computerised audit. Lothian Surgical Audit (LSA) has two components: the first is educational, in the form of a weekly meeting and an annual report; the second is the accurate recording of surgical activity by use of a simple three-digit code. The main message from LSA is that changes in surgical practice typically occur over 3 to 4 years, and require repeated education. Changes attributable to LSA include the establishment of specialist units, improved results after large-bowel surgery, and the demise of outmoded techniques. Audits should have a clear educational commitment, and be carried out long enough to allow for reauditing. The LSA software has been developed at minimal cost and is networked throughout Lothian hospitals. LSA provides clear evidence that regional audit can significantly influence and improve surgical practice. Its success has resulted from its surgeon-driven development, its flexible use in everyday practice, and the confidence it inspires in local surgeons.