The highs and lows of Medisoft as an audit tool: lessons from a 5-year upper eyelid ptosis audit.

Background: Increasing demand for surgeon accountability requires regular audit of individual and institutional performances. Electronic record systems proclaim efficient audit systems, but how does Medisoft live up to the hype? We present our experiences and examine how well Medisoft's audit suite meets clinical audit needs.

Methods: Medisoft audit suite was used to audit all ptosis procedures undertaken during 2010-14 in Gloucestershire Hospitals NHS Foundation Trust. Repeat audit identified all ptosis procedures done in the trust since Medisoft was introduced; these data were cross-referenced to determine true re-operation rates.

Results: 350 operations were performed on 304 patients over 427 eyes in 5 years. 40 of 304 patients (13%) have thus far required more than one operation on at least one eye. Cross-referencing the data revealed that 11 of these patients' audit-period operations were re-operations, and 18 patients were re-operated after the audit period. In total 26/40 patients (65%) would have been missed if the data had not been cross-referenced. 17 patients had post-operative complications recorded, 7 of whom had repeat surgery.

Conclusions: Medisoft supports high volume audits, reducing overall workload and increasing efficiency. However, consistent use across clinical staff is necessary to ensure all data are recorded and available for audit. When assessing re-operation rates, search parameters must be widened and cross-referenced to prevent missing vital information regarding procedures performed outside of the audit window. This could be eliminated in future if Medisoft made small changes to input of data that highlights repeat operations and their indications.