An audit of the surgical work-load in a urology unit.

ABSTRACT

OBJECTIVES: To assess the surgical work-load on a urology unit; to define the difference between case-load and work-load; and to assess the work-load in relation to surgical staffing levels. DESIGN: Prospective audit of all surgical procedures carried out on patients, excluding extracorporeal shockwave lithotripsy (ESWL), during a one year period, classified according to the British United Provident Association (BUPA) schedule of procedures. SETTING: One of the two urology units at the National Hospital of Sri Lanka, Colombo (NHSL). PATIENTS Inpatients having surgical procedures in one year. MAIN OUTCOME MEASURES: The number of surgical procedures, according to their complexity, with particular reference to the level of surgical staffing; difference between case-load and the actual work-load computed using the Intermediate Equivalent (IE) system of Jones and Collins (1). RESULTS: The annual surgical work-load on the urology firm was 1900 IEs. In our unit BUPA complex major, major plus and major operations comprised 27.2% of the case-load but accounted for about 47% of the work-load. The BUPA intermediate and minor procedures comprising the remaining 72.8% of the case-load accounted for only 53% of the work-load. Endoscopic urological procedures made up 71% of the work-load. The specialist surgeon and the senior registrar have contributed to 51.4% (977 IEs) and 40.2% (765 IEs) of the total work-load respectively. CONCLUSION: Case-load is a poor performance indicator of surgical activity. IE weighted work-load has been shown to reflect surgical activity more appropriately than case-load. A well trained senior registrar's contribution to the total surgical work-load is appreciable.