Surgical interhospital transfer mortality: national analysis

Area of Science:

• Surgical Patient Safety
• Healthcare Quality Improvement
• Mortality Auditing

Background:

• Interhospital transfers are an independent risk factor for surgical patient mortality.
• The Australian and New Zealand Audit of Surgical Mortality (ANZASM) assesses surgical mortality to improve care.
• This study focused on clinical management issues contributing to mortality in transferred surgical patients.

Purpose of the Study:

• To describe common clinical management issues in interhospital transfer surgical mortality.
• To identify themes and subthemes of these management issues.
• To inform quality-improvement initiatives for better surgical patient outcomes.

Main Methods:

• Data extracted from ANZASM for surgical mortality cases undergoing interhospital transfer in Australia (2010-2019).
• Surgeons' reports and assessor evaluations were analyzed to identify clinical management issues.
• Thematic analysis was employed to categorize identified issues.

Main Results:

• 8679 patients were identified; 25.0% had 3259 clinical management issues.
• Key themes included operative design (14.3%), decision to operate (13.0%), medical conditions (10.6%), diagnosis (10.0%), and transfer process (10.0%).
• Over 58% of identified issues were considered preventable.

Conclusions:

• 13 themes of potentially avoidable management issues were identified in surgical mortality post-transfer.
• Targeting these issues through quality-improvement initiatives can potentially reduce surgical patient mortality.
• Improving management during interhospital transfers is crucial for patient safety.