Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: A retrospective observational study

Abstract

Objective: Clinical management issues arecontributory factors to mortality. The aim of this studywas to use data from the Victorian Audit of SurgicalMortality (VASM), an educational peer-review processfor surgeons, to discover differences in the incidenceof these issues between surgical specialties in order tofocus attention to areas of care that might beimproved.Design: This study used retrospectively analysedobservational data from VASM. Clinical managementissues between eight specialties were assessed using?2 analysis.Data sources: VASM data were reported byparticipating public and private health services, theCoroner and self-reporting surgeons across Victoria.Results: A total of 2946 specific clinical issues asdeficiencies of care were reported. 15% of cases hadsignificant issues of care. The most common clinicalmanagement issue was the delay in delivery oftreatment. Other clinical issues included the quality ofcommunication and documentation, preoperative andpostoperative care, adverse events and protocol issues.There were significant differences in issues betweenspecialties.Conclusions: The clinical management issuespresented across surgical specialties were similar;however, five issues of clinical care differedsignificantly in frequency across surgical specialties.The three main issues varying among specialties werecomplications after operation, communication andpostoperative care. Addressing these clinicalmanagement issues via the peer-review process mayimpact positively on patient care.