Audit of Operation Notes During Wartime at Abuhamad Hospital, Sudan

Background Operative notes are vital for surgical practice, serving as critical records for postoperative care, clinical audits, and legal documentation. The Royal College of Surgeons of England (RCSEng) emphasizes the importance of detailed and structured notes. However, in conflict-affected and low-resource settings like Sudan, the quality of documentation is often poor due to staff shortages, inconsistent training, and the absence of standardized templates. This audit at Abuhamad Hospital aimed to assess operative note quality during wartime, implement corrective measures, and evaluate the outcomes. Material and methods The audit was conducted from August to November 2024, amid internal conflict, using a closed-loop, two-cycle model. In the first cycle, 28 retrospective notes were reviewed using 19 RCSEng-based criteria (e.g., patient details, surgeon name, procedure type, findings, complications, and postoperative instructions). Key deficiencies were identified, and a corrective intervention was introduced, including a standardized printed operative note template, focused staff training, and visual reminders in operating theatres. The second cycle prospectively assessed 33 operative notes post-intervention. Data were analyzed using Excel and SPSS version 25, and ethical approval was obtained. Result In total, 61 notes were audited. The first cycle revealed major gaps: only 9 (32.1%) documented the surgeon, anesthetist, or assistant, and just 1 (3.5%) recorded tissue/prosthesis details or antibiotic prophylaxis. Closure techniques and surgery type appeared in 4 (14.2%), while deep vein thrombosis (DVT) prophylaxis was entirely absent. Only 5 (17.8%) of notes were signed. Post-intervention, notable improvements were observed: documentation of closure techniques rose to 25 (75.8%), surgeon's name, diagnosis, and postoperative instructions to 25 (75.8%), anesthetist and operation time to 22 (66.7%), and date of operation to 24 (72.7%). Incision details and operative findings also improved substantially. Documentation of DVT prophylaxis increased to 8 (24.2%), and signatures to 13 (39.4%). The mean compliance across all parameters rose from 24.1% to 52.3%, a 28.2% improvement. Conclusion Structured documentation tools and focused training significantly enhanced operative note quality at Abuhamad Hospital, even during wartime. The findings align with both local and international evidence supporting low-cost, high-impact quality improvement methods. Despite a slight decline in documentation of postoperative instructions, the audit highlights the importance of standardization, ongoing training, and regular audits, particularly in resource-limited and unstable settings.