Fezan Mughal
Background
Accurate operative documentation is essential for continuity of care, outcome assessment, and compliance with national standards. The British Association of Dermatology (BAD) 2023 guidelines mandate documentation of excision margins and use of loupe magnification with bright theatre lighting. Baseline variability in operative note quality prompted a closed-loop audit of registrar-led day surgery lists.
Methods
A two-cycle closed-loop audit was conducted across registrar-led day surgery lists. Cycle 1 captured 42 primary skin cancer excisions (September–December 2024). Following introduction of a standardised digital operative note template (/skinop) and targeted departmental education, Cycle 2 prospectively captured 23 excisions (May–June 2025). Outcomes included peripheral and deep margin documentation rates, loupe/light documentation, and histological clearance. Standards were set at ≥90% for documentation and ≥95% for histological clearance.
Results
Peripheral margin documentation improved from 88.1% to 100%, and deep margin documentation from 83.3% to 91.3%, both meeting the ≥90% standard. Histological clearance improved from 92.9% to 95.7%, surpassing the target. Loupe and lighting documentation increased from 4.8% to 34.8%, though this remained below standard.
Conclusion
Implementation of a standardised digital proforma significantly improved operative documentation quality and histological clearance rates in registrar-led day surgery skin cancer lists. Digital templating offers a practical, scalable intervention to standardise communication and uphold national guidelines in ambulatory surgical settings.
Authors
Fezan Mughal, Benjamin Wood, Bernard Robertson
NHS Lothian, Edinburgh, United Kingdom