title: Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study.
abstract: 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.
  
  
  METHODS
  This study used retrospectively analysed observational data from VASM. Clinical management issues between eight specialties were assessed using χ(2) analysis.
  
  
  METHODS
  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.
authors: Victorian Audit of Surgical Mortality (VASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
authors: Jessele
authors: J
authors: Vinluan
authors: Victorian Audit of Surgical Mortality (VASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
authors: Claudia
authors: C
authors: Retegan
authors: Victorian Audit of Surgical Mortality (VASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
authors: Andrew
authors: A
authors: Chen
authors: Victorian Audit of Surgical Mortality (VASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
authors: Charles Barry
authors: CB
authors: Beiles
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008485:Medical Audit; D008511:Medicine; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D014739:Victoria; D055815:Young Adult
keywords: Surgery