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Mapping changes in surgical mortality over 9 years by peer review audit
A M Thompson1, Z Ashraf, H Burton
1Department of Surgery and Molecular Oncology, University of Dundee, Dundee, UK. a.m.thompson@dundee.ac.uk
The British Journal of Surgery
|July 6, 2005
Summary
Continuous peer review audit in Scotland improved surgical patient care over nine years. This led to fewer adverse events and deaths, highlighting the impact of changing clinical practices and facility provision.
Area of Science:
- Medical Auditing
- Surgical Patient Safety
- Healthcare Quality Improvement
Background:
- Increasing public scrutiny of surgical patient mortality necessitates examining practice changes.
- Analysis of patient deaths under surgical care aimed to identify temporal trends in management.
Purpose of the Study:
- To investigate changes in surgical and anaesthetic practice over time.
- To assess the impact of the Scottish Audit of Surgical Mortality (SASM) on patient outcomes.
Main Methods:
- Utilized data from the Scottish Audit of Surgical Mortality (SASM) spanning 9 years (1994-2002).
- Included data from peer review audits, critical event analyses, and individual feedback on deaths in surgical care.
- Examined trends over time in the management of patients who died under surgical care.
Main Results:
- Over 40,000 patient deaths were analyzed; consultant involvement in decision-making and operations significantly increased.
- Death rates after elective surgery declined to 0.27%.
- Adverse events, increasingly attributed to system failures rather than individual errors, decreased over time. Use of deep vein thrombosis prophylaxis and high-dependency/intensive therapy units improved.
Conclusions:
- Continuous peer review audit, exemplified by SASM, can drive improvements in surgical and anaesthetic practices.
- Changing clinical practices (e.g., DVT prophylaxis) and enhancing facility provision (e.g., HDU/ITU) can reduce adverse event rates.
- The SASM model offers a framework for quality improvement applicable to other medical specialties.