11 / 66
9
4. Recommendations for VASM clinical stakeholders
The recommendations outlined below are lessons learned from the audited surgical mortality cases. The treating
surgeons involved in these cases receive detailed reports and recommendations on issues of patient management
identified by the peer review assessors.
1. Improved leadership in patient care
•
In complex cases there must be clear, demonstrable leadership in patient management.
•
The treatment plan for each patient should be understood by all involved in their care.
•
The lead clinician must be accountable, responsive, prepared for challenges and must focus on
optimal patient care.
•
During lengthy operations there should be a low threshold for seeking assistance from colleagues to
avoid fatigue.
•
Senior surgical opinion is essential when dealing with surgical complications and should not be
delayed by team hierarchy structure.
2. Improved perioperative management
•
Appropriate preoperative, intraoperative and postoperative preparation and management aims to
decrease operative complications and promote successful recovery. Delay in, or unnecessary
preoperative investigations can have fatal consequences.
•
Preparation and management should include:
•
evaluation of both physical and psychological preparation
•
complete medical history and physical examination procedures
•
consent for the surgery and discussion of potential outcomes
•
appropriate documentation and communication of results with clinical and surgical teams, and
•
the avoidance of futile surgery through informed discussion with the patient and family.
•
The patient should be discharged to the ward with comprehensive orders.
•
Preventative measures should be implemented for reducing complications.
•
Instructions must be given about further management when the patient is discharged from a clinical or
surgical team.
•
The potential outcomes from the probable clinical diagnosis must be considered when developing a
treatment plan.
•
The patient should be transferred to a medical unit if elderly and high-risk. Also if medical issues are
assessed as being the prominent clinical factor during the admission episode, providing that the
surgical postoperative care can be performed appropriately in that setting.
3. Improved protocol compliance
•
All hospitals should have a formal protocol for early identification of clinical management issues and
immediate management plans. This protocol needs to be updated according to national guidelines
and policies.
•
Hospitals should follow protocols. Failure to follow hospital protocol or national clinical guidelines
during all parts of patient care can contribute to errors.
4. Action on evidence of clinical deterioration
•
Clinical deterioration should be monitored as it is an issue that is recognised throughout Australia and
internationally.
•
When clinical deterioration occurs and no clear cause is identified, consideration should be given to
causes outside the treating surgeon’s specialty or expertise.
•
Clinical findings must be considered alongside the results of investigations.
•
Clinical deterioration must be acted upon as well as recorded.
5. Improved awareness of surgical emergencies and sharing of care
•
The audit revealed that patients admitted as surgical emergencies are at greater risk where care is
shared. All health professionals should increase their awareness of this risk to improve the quality and
safety of patient care.