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Figures
Figure 1: The audit process. ........................................................................................................................................... 12
Figure 2: Matched mortality: VASM data compared with VAED data............................................................................. 15
Figure 3: Surgeon agreement to participate. .................................................................................................................. 16
Figure 4: Surgeon agreement to participate by surgical specialty. ................................................................................. 17
Figure 5: Cases by specialty that could not be reviewed due to non-participation......................................................... 18
Figure 6: Hospital origin of cases that could not be reviewed due to non-participation by treating surgeon. ................ 19
Figure 7: Frequency of reported causes of death. .......................................................................................................... 21
Figure 8: Reason for referral for second-line assessment (SLA).................................................................................... 23
Figure 9: Frequency of need for second-line assessment by specialty .......................................................................... 24
Figure 10: Frequency of individual surgical procedures ................................................................................................. 25
Figure 11: Seniority of surgeons performing surgery...................................................................................................... 27
Figure 12: Timing of operative procedures in emergency admissions. .......................................................................... 28
Figure 13: Unplanned return to the operating room........................................................................................................ 29
Figure 14: Seniority of consultants performing surgery during unplanned returns to the operating room...................... 30
Figure 15: Postoperative complications recorded by treating surgeon........................................................................... 31
Figure 16: Frequency of specific postoperative complications by urgency status.......................................................... 32
Figure 17: Postoperative complications by specialty. ..................................................................................................... 33
Figure 18: Clinically significant infections by specialty. .................................................................................................. 34
Figure 19: Perceived delays in establishing a diagnosis. ............................................................................................... 36
Figure 20: DVT prophylaxis use during the audit period................................................................................................. 37
Figure 21: Type of DVT prophylaxis used....................................................................................................................... 38
Figure 22: Reasons given by treating surgeon for not providing DVT prophylaxis......................................................... 39
Figure 23: Assessor perception of appropriateness of decision to withhold DVT prophylaxis. ...................................... 40
Figure 24: Provision of critical care support.................................................................................................................... 41
Figure 25: Provision of critical care support to patients by specialty. ............................................................................. 42
Figure 26: Perception of fluid balance appropriateness. ................................................................................................ 43
Figure 27: Interhospital transfer issues........................................................................................................................... 45
Figure 28: Perceived delays in transfer of patients to another hospital. ......................................................................... 46
Figure 29: Clinical management issues as identified by assessors................................................................................ 47
Figure 30: Trends of clinical management issues as assessed by assessors (FLA and SLA). ..................................... 49
Figure 31: Trends in areas of concern and adverse events in second-line assessments.............................................. 50
Figure 32: Trends in top five preventable clinical management issues in second-line assessments............................. 51
Figure 33: Frequency of adverse events and areas of concern by operative status. ..................................................... 52
Figure 34: Major outcomes regarding the perceived use of the VASM. ......................................................................... 54
Figure 35: Stakeholder recommendations for VASM's improvement. ............................................................................ 54