Search

Background: Necrotising fasciitis (NF) is a life‐threatening bacterial infection with high mortality. This retrospective study aimed to investigate patient characteristics and potential areas for improvement in clinical management in NF cases in Australia. Methods: Retrospective analysis of surgical death data from all public and private Australian hospitals in every state and territory, excluding New South Wales, collected through the Australian and New Zealand Audit of Surgical Mortality for the 9‐year period, January 2009 to February 2018. Results: A total of 290 NF cases were identified. Among these NF cases, obesity and diabetes mellitus were two of the most common comorbidities, with a prevalence of 26% and 41%, respectively. A total of 41 clinical management issues (CMIs) were identified among 36 NF cases. A larger proportion of NF cases had CMIs compared with non‐NF surgical mortality cases. Delay in diagnosis was the leading CMI (n = 28, 68.3%), followed by delay to surgery (n = 7, 17.1%). The majority of delayed diagnoses were attributed to non‐surgical clinicians in the hospital. Conclusion: CMIs were identified in a larger proportion of NF cases than in other non‐NF surgical mortality cases, suggesting that there are areas for improvement in NF diagnosis and management in Australia. The leading potentially avoidable issue identified in NF deaths was delay in diagnosis. This highlights the importance of awareness among non‐surgical clinicians that NF is a surgical emergency requiring urgent debridement. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify the most common potentially avoidable factors in urology deaths, focusing on the lessons that can be learnt. Methods: This study analysed data from a well‐established and comprehensive peer review audit of surgical deaths in Australian hospitals (excluding New South Wales) from 2009 to 2015, focusing on urology cases with identified areas for improvement in patient management. Of all audited deaths, 11% (79/719) had serious clinical management issues with a total of 109 individual clinical management issues identified. These were categorized based on perioperative stage (preoperative, intraoperative or post‐operative), followed by thematic analysis within each stage. Results: The study found preoperative issues to be the most common (n = 48), followed by post‐operative issues (n = 32) with intraoperative issues less common (n = 13). Communication issues were seen at all three stages (n = 16). Overall, the most common theme was at the preoperative stage; inadequate preoperative assessment (n = 27). More specifically, the most common preoperative assessment issues involved a failure to order necessary preoperative investigations, or to administer necessary preoperative treatment (e.g. prophylactic antibiotics). The most common communication issue was between teams and at handover, often involving failure by junior medical staff to communicate issues to the responsible surgical consultant. Conclusion: Urological surgical cases with potentially avoidable mortality constitute a small, but important subset of deaths. The analysis of these cases can inform various stakeholders to improve the quality and safety of urological surgical care. [ABSTRACT FROM AUTHOR]

Background Mortality rates are commonly used to evaluate the quality of surgical care; however, a large proportion of surgical deaths are unavoidable. Examination of the potentially avoidable issues in surgical deaths can provide a strong basis for quality improvement. Using data from a well-established and comprehensive national surgical mortality audit, we sought to identify the most common avoidable factors in neurosurgical deaths, focusing on the lessons that can be learnt. Methods This study analysed data from a peer review audit of surgical deaths in Australian hospitals (excluding New South Wales) from 2009 to 2014, focusing on neurosurgery cases with identified areas for improvement in patient management. In the 6% of neurosurgical cases that had clinical incidents, there were 193 clinical events identified. These were first categorized based on the perioperative stage (pre-, intra- or postoperative) followed by thematic analysis within each stage. Results The study found preoperative issues to be the most common ( n = 107) followed by postoperative issues ( n = 31) and intraoperative issues ( n = 29). The most common theme was inadequate assessment ( n = 65) followed by poor communication (at any stage of treatment) ( n = 26). Conclusion Neurosurgical cases with potentially avoidable mortality constitute a small but important subset. Avoidable contributors to mortality occurred most frequently at the preoperative stage, most commonly relating to inadequate assessment and delays. These findings can inform various stakeholders to improve the quality and safety of surgical care. [ABSTRACT FROM AUTHOR]

Abstract: High school-based introductory occupational safety education has become common and serves an important role in preparing students for entry into the workforce. However, the practices and perspectives of teachers have received limited attention. We sought to gather empirical data from high schools in South Australia and examine potential predictors of effective safety education. Focus groups and interviews with teachers and school to work advisors were undertaken and a questionnaire survey of teachers conducted. Potential predictors of perceived effective learning were grouped in terms of teacher-, school- and teaching-related characteristics. Of the 156 respondents from 103 schools, 16% had received no formal safety training, 86% felt that the school management was supportive, and 36% felt that their ability to teach the topic effectively was compromised due to other demands of their role. Although general learning guidelines were available, there was variability in the time spent, teaching methods and resources used. In a multivariate model, perceived student engagement was significantly associated with the use of case studies (adjusted odds ratio=2.2). The teaching of occupational safety in high schools would benefit by a standardized yet engaging approach, incorporating case studies. In-service teacher training with more explicit guidance on effective content and delivery is recommended. [Copyright &y& Elsevier]

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure worldwide. The aim of this study was to examine cases of mortality after ERCP to identify clinical incidents that are potentially preventable, to improve patient safety. Methods: The Australian and New Zealand Audit of Surgical Mortality provides an independent and externally peer‐reviewed audit of surgical mortality pertaining to potentially avoidable issues. A retrospective review of prospectively collected data within this database was performed for the 8‐year audit period from 1 January 2009 to 31 December 2016. Clinical incidents were identified by assessors through first‐ or second‐line review, and thematically coded into periprocedural stages. These themes were then qualitatively analysed. Results: There were 58 potentially avoidable deaths following ERCP, with 85 clinical incidents. Preprocedural incidents were most common (n = 37), followed by postprocedural (n = 32) and then intraprocedural (n = 8). Communication issues occurred across the periprocedural period (n = 8). Preprocedural incidents included delay to procedure, inadequate resuscitative management, decision to perform procedure and inadequate assessment. Intraprocedural incidents comprised technical factors and inadequate support. Postprocedural incidents involved inappropriate treatment, delay in definitive surgical treatment or in recognizing complications, inappropriate second‐line intervention and inadequate assessment. Communication incidents comprised inadequate documentation, failure to escalate care and poor inter‐clinician communication. Conclusion: Causes of mortality following ERCP are wide‐ranging, and reviewing clinical incidents associated with potentially avoidable mortality can serve to inform and educate practitioners. In collating a subset of cases in which procedure‐related mortality was deemed avoidable, a series of cautionary tales about ERCP is presented that may provide cues to practitioners on improving patient safety and inform future surgical practice. [ABSTRACT FROM AUTHOR]