Surgical inter‐hospital transfers: life saver or resource drainer?

Murshed, Ishraq; Gupta, Aashray K.; Kovoor, Joshua G; Maddern, Guy J.

doi:10.1111/ans.17786

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…There were four clinical incidents where assessors noted inadequate fluid resuscitation, with responsibility attributed to the transferring hospital, 17,18 emergency department (ED) and in two cases the surgical team. In four cases, it was felt by assessors that the patient would have benefited from admission to the ICU, due to medical complexity and severity of disease.…”

Section: Resultsmentioning

confidence: 99%

“…While the treating doctor at the peripheral hospital should have commenced antibiotics immediately upon diagnosis of cholangitis, assessors felt this also 'should have been part of the phone discussion when arranging the transfer'. There were four clinical incidents where assessors noted inadequate fluid resuscitation, with responsibility attributed to the transferring hospital, 17,18 emergency department (ED) and in two cases the surgical team. In four cases, it was felt by assessors that the patient would have benefited from admission to the ICU, due to medical complexity and severity of disease.…”

Section: Inadequate Resuscitative Managementmentioning

confidence: 99%

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Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8‐year qualitative analysis

Jolly

Chu

Gupta

et al. 2023

ANZ Journal of Surgery

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BackgroundEndoscopic 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.MethodsThe 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.ResultsThere 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.ConclusionCauses 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.

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Section: Resultsmentioning

confidence: 99%

Section: Inadequate Resuscitative Managementmentioning

confidence: 99%

Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8‐year qualitative analysis

Jolly

Chu

Gupta

et al. 2023

ANZ Journal of Surgery

Self Cite

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“…Geographical factors of health networks can produce significant discrepancies in the provision of health care between metropolitan and rural hospitals. Interhospital transfers (IHTs) can facilitate the delivery of timely surgical care within large health networks and resolve issues such as lack of appropriate resources at the index location, higher acuity of care requirement, or need for complex multidisciplinary specialist care 1 , 2 .…”

Section: Introductionmentioning

confidence: 99%

Surgical interhospital transfer mortality: national analysis

Murshed

Gupta

Camilos

et al. 2023

British Journal of Surgery

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Background Interhospital transfers of surgical patients are an independent risk factor for mortality. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) aims to improve surgical care through assessment of all cases of surgical mortality. This study aimed to describe common clinical management issues that contributed to interhospital transfer patient mortality. Methods Data for all surgical patient mortality in Australia (except New South Wales) that underwent interhospital transfer between 1 January 2010 and 31 December 2019 were extracted from ANZASM. The surgeons’ reports and assessors’ evaluations were examined to identify clinical management issues. Thematic analysis was performed to develop pertinent themes and subthemes. Results Some 8679 patients were identified over the 10-year period. Of these, 2171 (25.0 per cent) had 3259 clinical management issues identified. Prominent themes were operative design (n = 466, 14.3 per cent), decision to operate (n = 425, 13.0 per cent), medical conditions (n = 344, 10.6 per cent), diagnosis (n = 326, 10 per cent), transfer (n = 293, 10.0 per cent), intraoperative issues (n = 278, 8.5 per cent), inadequate assessment (n = 238, 7.3 per cent), communication (n = 224, 6.9 per cent), delay in recognizing complications (n = 180, 5.5 per cent), coagulopathy (n = 151, 4.6 per cent), insufficient monitoring (n = 127, 3.9 per cent), infection (n = 107, 3.3 per cent), and hospital resources (n = 100, 3.1 per cent). Assessors considered 58.4 per cent of clinical management issues (n = 1903) probably or definitely preventable. Conclusion This study identified 13 themes of potentially avoidable management issues present in surgical mortality following interhospital transfers. Quality-improvement initiatives targeting these areas may improve surgical patient outcomes.

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Promoting good practice before, during and after transfers

Watters

Brown

2022

ANZ Journal of Surgery

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Surgical inter‐hospital transfers: life saver or resource drainer?

Cited by 5 publications

References 13 publications

Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8‐year qualitative analysis

Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8‐year qualitative analysis

Surgical interhospital transfer mortality: national analysis

Promoting good practice before, during and after transfers

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