Organisational failures in urgent and emergency surgery. A potential peri-operative risk factor.
Medical error is an important cause of morbidity and mortality. Organisational failure in the pre-operative period has been associated with catastrophic outcome. Little information is available regarding peri-operative organisational problems. The incidence and nature of organisational failure before urgent and emergency surgery in a district general hospital was studied prospectively in 159 cases over a 30-day period. Organisational failure affected more than half of the cases overall, but varied in both its incidence and its complexity between surgical disciplines. Various causative factors were identified, e.g. 8% of cases were subject to delay due to clinical emergencies. The median [range] time required to rectify the problems was 115 [5-750] min. A consultant anaesthetist and surgeon were present in 30 and 20% of cases, respectively. Difficulty with the preparation of patients for emergency surgery is an important but underevaluated cause of medical error that may put patients at risk.
Pearse
R M
RM
Department of Anaesthesia, Mayday University Hospital, London Road, Croydon CR7 7YE, UK. rupert@putney.demon.co.uk
Dana
E C
EC
Lanigan
C J
CJ
Pook
J A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004630:Emergencies; D004635:Emergency Medicine / Q000458:organization & administration; D005260:Female; D013502:General Surgery / Q000458:organization & administration*; D006767:Hospitals, District / Q000458:organization & administration / Q000592:standards; D006769:Hospitals, General / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008131:London; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D011300:Preoperative Care / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D013038:Specialization