F T McDermott1, S M Cordner, A B Tremayne. 1. Department of Surgery, Monash University, Alfred Healthcare Group, Alfred Hospital, Prahran, Victoria, Australia.
Abstract
BACKGROUND: In 1992 a multidisciplinary committee was established to identify problems in the management of road fatalities in Victoria, Australia, to assess their contribution to death, and to identify preventable deaths (preventable: survival probability more than 75%; potentially preventable: survival probability between 25 and 75%). METHODS: For 1993-94, 120 consecutive fatality cases surviving until arrival of ambulance services were evaluated by analysis and discussion of their complete pre-hospital, hospital and autopsy records. RESULTS: A total of 1175 problems were identified in 455 admission to the various areas of care. A total of 949 problems (81%) were found to be management errors and 123 (11%) were found to be system inadequacies. Technique errors (35 (3%)), diagnosis delays (27 (2%)) and diagnosis errors (41 (4%)) were less frequent. The emergency department (ED) accounted for 662 (56%) problems, followed by 191 (16%) pre-hospital problems and 140 (12%) intensive care unit (ICU) problems. There were 598 (51%) problems that were assessed as contributing to death. A total of 308 (52%) problems occurred in the ED, 106 (18%) were pre-hospital problems and 71 (12%) occurred in ICU. Management errors comprised 465 (78%) problems contributing to death, and system inadequacies comprised 76 (13%) problems. Resuscitation problems accounted for 101 (40%) of the 254 ED management errors contributing to death. A total of 79 (66%) deaths were assessed as non-preventable, five (4%) were assessed as preventable and 36 (30%) were assessed as potentially preventable. CONCLUSIONS: Organization and educational countermeasures are required to reduce the high frequency of problems in emergency services and clinical management.
BACKGROUND: In 1992 a multidisciplinary committee was established to identify problems in the management of road fatalities in Victoria, Australia, to assess their contribution to death, and to identify preventable deaths (preventable: survival probability more than 75%; potentially preventable: survival probability between 25 and 75%). METHODS: For 1993-94, 120 consecutive fatality cases surviving until arrival of ambulance services were evaluated by analysis and discussion of their complete pre-hospital, hospital and autopsy records. RESULTS: A total of 1175 problems were identified in 455 admission to the various areas of care. A total of 949 problems (81%) were found to be management errors and 123 (11%) were found to be system inadequacies. Technique errors (35 (3%)), diagnosis delays (27 (2%)) and diagnosis errors (41 (4%)) were less frequent. The emergency department (ED) accounted for 662 (56%) problems, followed by 191 (16%) pre-hospital problems and 140 (12%) intensive care unit (ICU) problems. There were 598 (51%) problems that were assessed as contributing to death. A total of 308 (52%) problems occurred in the ED, 106 (18%) were pre-hospital problems and 71 (12%) occurred in ICU. Management errors comprised 465 (78%) problems contributing to death, and system inadequacies comprised 76 (13%) problems. Resuscitation problems accounted for 101 (40%) of the 254 ED management errors contributing to death. A total of 79 (66%) deaths were assessed as non-preventable, five (4%) were assessed as preventable and 36 (30%) were assessed as potentially preventable. CONCLUSIONS: Organization and educational countermeasures are required to reduce the high frequency of problems in emergency services and clinical management.
Authors: Angela Lashoher; Eric B Schneider; Catherine Juillard; Kent Stevens; Elizabeth Colantuoni; William R Berry; Christina Bloem; Witaya Chadbunchachai; Satish Dharap; Sydney M Dy; Gerald Dziekan; Russell L Gruen; Jaymie A Henry; Christina Huwer; Manjul Joshipura; Edward Kelley; Etienne Krug; Vineet Kumar; Patrick Kyamanywa; Alain Chichom Mefire; Marcos Musafir; Avery B Nathens; Edouard Ngendahayo; Thai Son Nguyen; Nobhojit Roy; Peter J Pronovost; Irum Qumar Khan; Junaid Abdul Razzak; Andrés M Rubiano; James A Turner; Mathew Varghese; Rimma Zakirova; Charles Mock Journal: World J Surg Date: 2017-04 Impact factor: 3.352
Authors: Roman Pfeifer; Sascha Halvachizadeh; Sylvia Schick; Kai Sprengel; Kai Oliver Jensen; Michel Teuben; Ladislav Mica; Valentin Neuhaus; Hans-Christoph Pape Journal: World J Surg Date: 2019-10 Impact factor: 3.352