Australia: Public hospital deaths, mistakes spark surgery audit

All surgical deaths in hospitals will be audited under a plan designed to detect system failures and medical errors that kill or harm thousands of patients a year. The national plan will be based on a West Australian audit of all surgery-related patient deaths which since 2001 has identified systemic problems and resulted in nationwide changes in surgical practice. Ninety-six per cent of West Australian surgeons took part in the audit, which achieved a progressive fall in the number of surgical deaths caused by poor clinical care, the project director, James Semmens, writes in the The Medical Journal of Australia today.

Of 876 surgery-related deaths, the audit found 45 (or 5 per cent) were caused by adverse events and 15 of those were considered preventable. There are 150,000 operations in Western Australia each year, he writes. The audit found most people who died were elderly and had other serious problems such as cardiovascular, respiratory, kidney or psychiatric diseases, the medical journal reports.

Three-quarters of the West Australian surgeons said they had changed their practices as a result of the audit and were more likely to advise patients and relatives against further surgical intervention if they believed it would not improve the condition. The audit has already forced a national change in medication given to patients before surgery, after it was discovered that too few had been given a drug to prevent deep-vein thrombosis, a common surgical complication. The audit also found that emergency patients had been given too much fluid, which often made them sicker. System-wide changes were put in place to avoid over-hydrating.

The Royal Australasian College of Surgeons aims to have every surgeon in the country voluntarily participate in the national audit, and there are hopes that New Zealand doctors will join the program next year. Along with changing surgical practice, the results would also be used to pressure politicians to legislate reform, the college's chairman of research and audit, Guy Maddern, told the Herald. "To have got to this stage is extraordinarily heartening but the real value will be in 12 months' time, when we get data and influence change," he said. "The results in WA have already improved the safety and quality of care by providing feedback to surgeons, hospitals and government that highlight system failures, which have prevented a recurrence of adverse events."

Previous studies had shown an error rate resulting in patient death or harm in Australian hospitals of between 10 per cent and 16 per cent. The West Australian program identified an overall error rate resulting in death of about 5 per cent. It found elective surgery patients were almost twice as likely to die as a result of technical errors. Emergency patients often died as a result of delays in getting treatment.

The chief executive officer of the NSW Clinical Excellence Commission, Cliff Hughes, said this state would be rolling out its audit area by area, starting with the Sydney South Western Area Health Service early next year. Professor Hughes is enthusiastic about the potential for the national audit to save lives. "You can identify areas of concern and use it as an educative experience for surgeons," he said. "I am delighted we are one step further toward complete, transparent reporting."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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