How participation in surgical mortality audit impacts surgical practice

Abstract

BackgroundSurgical mortality audit is an important tool for quality assurance and professional development but little is known about the impact of such activity on professional practice at the individual surgeon level. This paper reports the findings of a survey conducted with a self-selected cohort of surgeons in Queensland, Australia, on their experience of participating in the audit and its impact on their professional practice, as well as implications for hospital systems.MethodsThe study used a descriptive cross-sectional survey design. All surgeons registered in Queensland in 2015 (n = 919) were invited to complete an anonymous online questionnaire between September and October 2015. 184 surgeons completed and returned the questionnaire at a response rate of 20%.ResultsThirty-nine percent of the participants reported that involvement in the audit process affected their clinical practice. This was particularly the case for surgeons whose participation included being an assessor. Thirteen percent of the participants had perceived improvement to hospital practices or advancement in patient care and safety as a result of audit recommendations. Analysis of the open-ended responses suggested the audit experience had led surgeons to become more cautious, reflective in action and with increased confidence in best practice, and recognise the importance of effective communication and clear documentation.ConclusionsThis is the first study to examine the impact of participation in a mortality audit process on the professional practice of surgeons. The findings offer evidence for surgical mortality audit as an effective strategy for continuous professional development and for improving patient safety initiatives.

Systemic predictors of adverse events in a national surgical mortality audit: analysis of peer‐review data from Australia and New Zealand Audit of Surgical Mortality

“…The former have been shown to result in a reduction in surgical mortality, presumably mediated by increased vigilance for potential errors. Participation in a cross‐institutional reporting system for surgical deaths may itself engender a culture of caution, reflection and best practice . Indeed, the ANZASM process could be seen as an intentional application of the Hawthorne effect, whereby an individual's behaviour is altered simply by virtue of being observed …”

“…Participation in a cross-institutional reporting system for surgical deaths may itself engender a culture of caution, reflection and best practice. [10][11][12] Indeed, the ANZASM process could be seen as an intentional application of the Hawthorne effect, 13 whereby an individual's behaviour is altered simply by virtue of being observed. 14,15 Declining temporal trends in FLAE reporting may also partly reflect reviewer fatigue.…”

Post‐mortem general surgeon reflection on decision‐making: a mixed‐methods study of mortality audit data

“…Lui et al . showed that surgeons who participate in a mortality audit change their clinical practice . Furthermore, surgeons who play an active role in the audit process benefit the most .…”

“…29 Furthermore, surgeons who play an active role in the audit process benefit the most. 29 Surgeons who passively participate by only completing the SCF (not volunteering to take part in the QASM firstand second-line assessment processes as outlined in Methods section) miss out on this educational opportunity. The scientist author Jim Horning's oft-repeated statement 'good judgment comes from experience and experience comes from bad judgment' implies a 'bad' surgeon is not the one with patients whose outcomes were undesirable, but the surgeon who lacks a process which allows them to appraise and change their practice.…”

Learning from regret

“…Regret can also have a positive consequence: rumination about whether different decisions and actions might have resulted in a better outcome may be an important coping strategy for surgeons that can also generate learning and improved future practice. Learning through self‐reflection after surgical incidents can promote mindfulness of the possibilities of adverse events, and can have a powerful impact on changing or reinforcing patient safety behaviours.…”