John H. Lunn, M.D., FFARCS
University of Wales
College of Medicine, Cardiff
“The trouble is you haven’t included the surgeons and your data will be valueless.” That’s what they said about Mortality Associated with Anesthesia before the report was published. But they were wrong. That study showed how safe anesthesia is (one in 10,000 operations followed by death wholly attributable to anesthesia) and that the few deaths were often avoidable and usually attributable to human error.
Encouraged by the response to this study, the Association of Anesthetists of Great Britain and Ireland sought and obtained funds (from the Snuffled Provincial Hospital Trust and the King’s Fund for Hospitals) to support another large project which has recently started in the United Kingdom. This unique study involves all surgical disciplines as well as anesthesia and is a fully cooperative venture between the Association of Anesthetists of Great Britain and Ireland and the Association of Surgeons of Great Britain and Ireland. The aims of now the study are the same as before: mortality rates(perhaps for a few specific operations as well as to global rates), and to identify avoidable factors in that deaths which occur in hospital within 30 days of operation.
More than 400 assessors have been appointed University of Wales, in both disciplines. These experts will review all College of Medicine, Cardiff the deaths about which there is any doubt and a random sample of all other deaths. Their opinions will form the basis of the report which will be published after the study has continued for 12 months. Three Regions of the country have been selected (estimate 600,000 operations) and every hospital (60) visited by two clinical coordinators (a surgeon, H. B. Devlin) and an anesthetist (the writer). The response to this recruitment drive has exceeded our expectations and a total of about 96% of the consultant staff has agreed to cooperate; it is still a voluntary matter.
When a death occurs, each specialist completes a detailed questionnaire designed to provide information about the management of the case. These questionnaires are examined by the two clinical coordinators, stripped of their identity, and then sent to the appropriate assessors.
Questionnaires are arriving at the office daily and in the first six weeks of the project, over 1000 have been scrutinized. It is no exaggeration to claim that British anesthetists and surgeons are prepared to examine their own practice and expose it to peer review. We have evidence this audit process is already provoking the most recalcitrant to change and, we hope, to improve in practice.