26 / 66
24
Comments:
•
The need for SLA has decreased over time, in part because the quality of the information provided in the SCFs
returned by treating surgeons has improved. The percentage of cases referred for SLA due to insufficient
information has dropped significantly; from 13.5% in 2007–2012 to 7.6% in 2014–2015. Cases with an ASA score
greater than or equal to 4 were significantly more likely to be referred for SLA (
p
<0.001) (data not shown).
•
In 82.8% (5,119/6,179) of audited cases the first-line assessor did not refer the case for SLA.
•
30.3% (319/1,052) of second-line assessment requests were made based on the need for a more detailed review
of perceived issues of management.
•
There have been improvements in the quality of the data provided to the VASM since 2007; however, ongoing
issues remain with the quality of the data provided by some treating surgeons. Greater attention to detail in
completing the SCF would help reduce the workload of colleagues who have agreed to act as first- and second-
line assessors, and the quality assurance and medical records representatives at collaborating hospitals.
•
In 24.2% (255/1,052) of SLAs at least one aspect of the patient medical record submitted to the assessor was
deemed unsatisfactory from SLA pool that required further investigation. Criticisms included poor medical
admission notes and follow-up records and unsatisfactory description of the surgical procedure. The hospital case
notes are an important record of what occurred during a patient’s treatment. The difficulty in managing patients in
a complex environment, where there is an increasing lack of continuity in the care provided during a patient’s stay
in hospital, is exacerbated by poor and inaccurate clinical notes.
Figure 9: Frequency of need for second-line assessment by specialty
Note: total n= 6,179.
Audit period 1 July 2007 to 30 June 2015.
Data not available: n=7 (<1%).
Smaller specialties such as Oral/maxillofacial, Ophthalmology, Oncology and Trauma were excluded due to small numbers
.
Comments:
•
The need for SLA referral varied between specialties. Gynaecology had the highest percentage of cases referred
for SLA; however no inferences can be made, as Gynaecology was a new specialty recruited in 2013.
•
The need for referral for SLA was similar in metropolitan and rural regions (data not shown).
0%
20%
40%
60%
80% 100%
All surgeries
Vascular Surgery
Urology
Plastic Surgery
Paediatric Surgery
Otolaryngology Head and Neck Surgery
Other surgeries
Orthopaedic Surgery
Neurosurgery
Gynaecology and Obstetrics
General Surgery
Cardiothoracic Surgery
Assessment status
Specialty
First-line Second-line
100%
Specialties with SLA referral
2007-2014
100%
Specialties with SLA referral
2014-2015