Perioperative and perinatal death as measures for quality assurance.

The concept of avoidable death is increasingly used both epidemiologically and clinically as an indicator of the quality of health services. This paper examines practical experience, particularly in Britain and Europe, of the organisation and impact of collaborative mortality studies in improving patient care in surgery and perinatal services. It suggests that the technical inadequacies of such studies are small compared with their benefits--as long as their message is translated into local practice. It offers some key ingredients for effective collaborative mortality studies.