AUSTRALIAN PUBLIC HOSPITALS KILL PATIENTS REGULARLY

One in five people who died after surgery received deficient care, and one in 50 died as a direct result of an error or misjudgement, Australia's first audit of surgical deaths shows.

The West Australian analysis, which will now be extended nationwide, found serious problems with the way fluids were administered and monitored after surgery. Fluid problems - typically involving lung failure after excessive hydration - were implicated in 11 per cent of the 179 surgical deaths that occurred in the state in 2004 in which deficient care was considered a factor.

The total number of surgical deaths was 876, but in 80 per cent of cases the care was judged to have been appropriate. The report also identified problems with continuity, when a person came back to hospital for a repeat operation but was admitted under the care of a different doctor who was not fully aware of the patient's medical history.

James Aitken, who runs the audit program, said public hospital employment practices - in which surgeons were paid to work shifts and were not officially on call at other times - contributed to that problem. Many surgeons also worked at private hospitals, which could raise a dilemma if an emergency arose.

But the audit showed some improvements since data collection began in 2002, with fewer operations performed on very sick people where there was no chance of success, and more consistent action to prevent the development of deep vein thrombosis - potentially lethal blood clots that can occur when people are immobilised after surgery. Three-quarters of the doctors said they had made changes in the way they practised after feedback from the program.

Dr Aitken said 95 per cent of West Australian surgeons were now taking part in the voluntary audit, which helped doctors improve their performance by becoming more aware of potential pitfalls. When a patient died under their care, the surgeons forwarded case notes to the audit team, which in turn asked independent experts to comment on whether there had been faults in the person's care, and whether the death might have been prevented.

But patients' families could not gain access to the case reports, protected under freedom-of-information legislation. Russell Stitz, the president of the Royal Australasian College of Surgeons, said surgeons in several states had recently begun contributing to a national audit, but funding negotiations were continuing in NSW.

There were no imminent plans to require surgeons to report deaths under their care, Dr Stitz said. "We'd rather put them in the position where if they don't do it, a cloud falls over their head." And the college would resist public disclosure of individual surgeons' death rates. "If we say we're going to identify the surgeons publicly, they'll run a mile. We will look at someone who's at variance [with normal performance] and remediate them," said Dr Stitz. "We need surgeons. We'd rather get them back up to speed."

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