Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

OBJECTIVE: Clinical management issues are contributory factors to mortality. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM), an educational peer-review process for surgeons, to discover differences in the incidence of these issues between surgical specialties in order to focus attention to areas of care that might be improved. DESIGN: This study used retrospectively analysed observational data from VASM. Clinical management issues between eight specialties were assessed using χ(2) analysis. DATA SOURCES: VASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria. RESULTS: A total of 2946 specific clinical issues as deficiencies of care were reported. 15% of cases had significant issues of care. The most common clinical management issue was the delay in delivery of treatment. Other clinical issues included the quality of communication and documentation, preoperative and postoperative care, adverse events and protocol issues. There were significant differences in issues between specialties. CONCLUSIONS: The clinical management issues presented across surgical specialties were similar; however, five issues of clinical care differed significantly in frequency across surgical specialties. The three main issues varying among specialties were complications after operation, communication and postoperative care. Addressing these clinical management issues via the peer-review process may impact positively on patient care.