Table 3 Major Categorised Themes, Examples, and Frequencies of Open-ended Survey Responses to Questions on Clinical and Hospital Practices
From: How participation in surgical mortality audit impacts surgical practice
Major Categorised Theme | Example | Reply No. (%) |
|---|---|---|
Impacts on Clinical Practice | n = 59 | |
Be more reflective by learning from mistake/approach of others | ‘Gives you clinical situations to consider, and put yourself in same position. What would I do differently.’ ‘I reflect on how I might have managed the patient and put myself in their shoes when I do the assessment.’ ‘It has made me more aware of how to try and avoid problems within my field of practice.’ | 24 (41%) |
Become more considered in action or decision- making | ‘I try to make sure all bases covered and all contingencies have been considered before I choose a course of action.’ ‘In one instance it prompted me to do follow up radiology routinely rather than only when there were worrying symptoms.’ ‘Acts as a reminder to be careful regarding pre-operative preparation.’ | 13 (22%) |
Recognise importance of effective communication and clear documentation | ‘Ensured I made verbal handovers to fellow consultants to ensure subtle points were not lost via ‘registrar to registrar’ handover.’ ‘Doing assessments emphasises the importance of early consultation with consultants and clear.’ documentation of consultant input.’ ‘Reminded me of the importance of informative and legible notes.’ | 7 (12%) |
Increase in confidence on practice | ‘Useful information to take into consideration for future cases. Also useful to know that an independent reviewer finds that your care had no concerns etc. in their opinion.’ ‘Useful to be reassured re practice.’ ‘Feel reassured.’ | 4 (7%) |
Impacts on Hospital Practice | n = 19 | |
Improve procedure and patient management (organisation level) | ‘Increased access to theatres for emergency cases.’ ‘Greater focus on avoiding delays in treatment as delays are repeatedly shown to have a negative impact on outcomes.’ ‘Encouragement of better written notes by consultants.’ | 10 (53%) |
Improve patient care and safety (theatre level) | ‘More consultant leadership on surgical units.’ ‘More attention to detail where deaths have occurred and more stringent protocols in the OT [operating theatre].’ ‘More vigilant in non orthopaedic care of morbidities that have potential to influence the outcome of orthopaedic surgery.’ | 4 (21%) |
Changes recommended for Hospital Practice | n = 40 | |
Better audit process and feedback use | ‘Only selected centres should be entitled to undertake some procedures a robust MDT [multi-disciplinary team] + M/M [morbidity and mortality] + Audit is required in centres wishing to undertake complex surgeries.’ ‘The distribution of feedback is not clear to me. I have seen situations where changes to a hospital system would seem desirable but I do not know if that ever is fed back.’ ‘All hospitals should have a VMO [visiting medical officers] committee which includes a physician, surgeon, oncologist, anaesthetist and intensivist to review all inpatient deaths.’ | 11 (28%) |
Better consultant involvement and leadership | ‘In clearly complicated cases, it would be appropriate for senior consultants to give an opinion on care and management of cases particularly in cases of advanced malignancy when palliative care may be more appropriate than operative intervention.’ ‘In regional hospitals, mandated earlier consultant involvement in unwell patients; by which I mean having the consultant physically attend the patient.’ ‘Consultant should be in OT [operating theatre] for all [patients] take back to theatre for [due to] complications (not just a reg [registrar] alone).’ | 11 (28%) |
Improve procedure, facilities and training | ‘Simplifying referral pathways.’ ‘Continuity of care. Access to emergency operating in normal hours.’ ‘Junior doctors need to understand fluid physiology.’ | 6 (15%) |
Improve management of frail or elder patients | ‘Better assessment and triage of frail patients for whom surgical intervention would be futile.’ ‘Dedicated NOF [neck of femur] lists or priority for elderly fracture patient reduces morbidity and mortality- and reduces bed stay and surgeon frustration. This should be supported in every Queensland Hospital.’ ‘Falls prevention in hospitals needs to be more than just filling in a form and moving their bed closer to the desk.’ | 5 (13%) |
Improve communication and documentation | ‘Accurate documentation in M&M [morbidity and mortality] meetings.’ ‘Two step change. Firstly establish an ASU [acute surgical unit] and secondly establish compulsory consultant to consultant communication protocols.’ ‘More detailed notes on treatment and discussions with colleagues and families and more second opinions!’ | 3 (8%) |