Scottish Audit of Surgical Mortality

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Scottish Audit of Surgical Mortality

• Stirling, 8th September 2005
• a.m.thompson_at_dundee.ac.uk

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SASM

• Completion of proformas (surgeon/ anaesthetist)
• First line assessment
• Case Note Review
• Feedback

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One way to do Case Note Review

• Case Notes Arrive
• Set notes aside
• Keep notes safe
• Keep notes together
• Treat like a formal patient or legal opinion
• Identify time within the next week to do the
  case note review.

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How to do Case Note Review

• Quiet setting
• Allow adequate time
• (?1 hour)
• Adequate space
• No interruptions
• Skim through the notes to determine their layout
• (re-)organise the bits

• Pay particular attention to
• Clinical notes (OP, ward, HDU/ITU)
• Operation note(s)
• Discharge summaries
• Nursing notes
• Integrated care pathways.

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Actually Doing the Case Note Review

• Read through the (re- ) organised case notes
• Make notes as you go
• Write/type/dictate a
• background,
• a sequence of events,
• learning points,
• areas of good practice and
• deficiencies of care (if any)

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Actually Doing the Case Note Review - Revision

• Have I been thorough?
• Have I been concise (lt1page A4)?
• Can I cite any evidence in support of my opinion?
• How have I phrased it/ would I be upset if I
  received this review?
• What are the deficiencies of care the adverse
  events, areas of concern or for consideration?
• Would I be willing to sign this?

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Future Considerations

• Quality reviews
• Transparency
• How do we recompense assessors?
• Root Cause Analysis

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