Surgeon-led mortality review can improve patient outcomes

Findings highlight importance of systematic review of mortality rates, PSIs and HACs
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Surgeon-led mortality reviews resulted in improved observed-to-expected ratios and University HealthSystem Consortium postsurgical relative rankings, according to a study published in the Journal of the American College of Surgeons.

Researchers from the Department of Surgery at the University of Alabama, led by Martin J. Heslin, M.D., examined data from December 2012 through August 2013 after surgeons from 12 services documented and reviewed mortality rates, patient safety indicators (PSI) and hospital acquired conditions (HACs) from 11,899 patients, according to the study abstract.

Each month, one surgeon from each service led a review of all incidents with reporting of preventability and coding accuracy, comparing the University HealthSystem Consortium observed-to-expected ratios and relative rankings before and after the reviews were implemented.

Of the 235 deaths, 290 PSIs and 26 HACs identified and reviewed, postoperative deep venous thrombosis or pulmonary embolism, respiratory failure, hemorrhage or hematoma, and accidental puncture or laceration were the most common PSIs. Postoperative mortality ranking improved from 109 of 118 in the third quarter of 2012, to 47 of 119 in the third quarter of 2013, according to the study.

"Surgeon led systematic review of mortality, PSIs and HACs improved our OE ratio and UHC postsurgical relative rankings," the authors wrote. "Surgeon engagement and ownership is critical for success."

Researchers also recommended the following elements when conducting surgeon-led reviews, according to Medscape:

  • Encourage both attending physicians and residents to contribute to frank discussions about ways to improve;

  • Clearly and categorically define reasons for preventable complications;

  • Use Clinical Service Reports to carefully analyze and follow the patient's track 24 hours after the initiating event;

  • Collate all events across the department of surgery, rather than within any single service to determine general themes;

  • Gather information from hospital data resources and distribute as appropriate; and

  • Seek leadership support.

Programs to improve patient safety are already on the books at Johns Hopkins Hospital, which implemented a comprehensive unit-based safety program, FierceHealthcare previously reported. The five-step strategy empowers frontline staff, such as nurses and medical techs, to identify problems in the operating room, such as antibiotic selection and dosing, skin preparation, maintenance of normal body temperature and intra-operative sterile techniques. The program reduced infection rates from 27.3 percent to 18.2 percent in just one year.

To learn more:
- here's the study abstract
- read the Medscape article

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