Abstract：
BACKGROUND:Clinical decision making is a core competency of surgical practice, involving a continuous and evolving process of data interpretation and evaluation. The aim of this article is twofold. First, to recognize patient deaths where a clinical incident arose following unsatisfactory clinical decision making, determining where in the clinical decision-making process each failure occurred. Second, to discuss and explore individual incidents to provide lessons from which the surgical community can learn. METHODS:Using the Australian and New Zealand Audit of Surgical Mortality database, all deaths from 1 January 2015 to 31 December 2015 were analysed. All deaths in which the surgeon or assessor identified an aspect of patient management that was inadequate were recognized. Clinical incidents deemed by the assessor to be an area of concern or an adverse event were individually reviewed to determine if a clinical decision-making incident (CDMI) occurred. CDMIs were categorized into various themes depending on the nature of the incident. RESULTS:A total of 3422 fully audited deaths occurred throughout the study period; from these cases, 226 individual CDMIs were identified. Decision to operate was the most commonly identified CDMI (n = 99, 43.8%), followed by diagnostic error (n = 49, 21.7%). The least common CDMI identified was inadequate post-operative assessment (n = 14, 6.2%). CONCLUSION:This paper demonstrates thought-provoking examples of clinical decision-making failure implicated in patient death. Clinical decision-making failures most commonly occur around the decision to operate with increased discussion of complex cases possibly required. Further CDMI evaluation should be considered to complement more traditional methods of surgical mortality evaluation.
journal_name
ANZ J Surgjournal_title
ANZ journal of surgeryauthors
Davis SS,Babidge WJ,McCulloch GAJ,Maddern GJdoi
10.1111/ans.14955subject
Has Abstractpub_date
2019-06-01 00:00:00pages
764-768issue
6eissn
1445-1433issn
1445-2197journal_volume
89pub_type
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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pub_type： 杂志文章
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