Semmens James B, Mountain Jenny A, Sanfilippo Frank M, Barraclough Jenny Y, McKenzie Anne, Mukhtar S Aqif, Haynes Natasha S, Aitken R James
Centre for Health Services Research, School of Population Health, The University of Western Australia, Crawley, Australia.
ANZ J Surg. 2006 Jun;76(6):442-7. doi: 10.1111/j.1445-2197.2006.03748.x.
The Western Australian Audit of Surgical Mortality (WAASM) was established in June 2001 to independently peer-review all surgical deaths in Western Australia. The objectives of this study were (i) to evaluate whether participation in the WAASM has influenced clinical and hospital practice; and (ii) to ascertain the support and relevance of the WAASM to surgeons, hospitals and consumers.
Three qualitative questionnaires were designed to evaluate the response of surgeons, hospital administrators and consumers to the WAASM. The outcomes measured included audit participation, value and use of feedback provided, changes to clinical and hospital practice and the future role of the WAASM.
The key findings were that 138 (73%) of 190 surgeons participating in the WAASM had changed their clinical practice in at least one way, 44 (24%) were aware of changes in hospital practice and 21 (11%) were aware of changes in a colleague's practice. Particular areas where changes in surgical practice had occurred included attention to deep vein thrombosis prophylaxis (81, 44%), increased constructive discussion among peers (78, 42%) and quality of documentation in case notes (68, 37%). All groups supported the continuation of the WAASM. Hospital executives and consumers recommended that the WAASM be included in accreditation.
Surgeons, hospitals and consumers supported the concept of independent peer review of surgical care. They confirmed the ability of audit to influence and change surgical and hospital practice. It strengthens the intention of the Royal Australasian College of Surgeons to extend the WAASM project throughout Australia and New Zealand.
西澳大利亚外科手术死亡率审计（WAASM）于2001年6月设立，旨在对西澳大利亚所有外科手术死亡病例进行独立同行评审。本研究的目的是：（i）评估参与WAASM是否影响了临床和医院实践；（ii）确定WAASM对外科医生、医院和消费者的支持程度及相关性。
设计了三份定性调查问卷，以评估外科医生、医院管理人员和消费者对WAASM的反应。所测量的结果包括审计参与情况、所提供反馈的价值和使用情况、临床和医院实践的变化以及WAASM的未来作用。
主要发现为，参与WAASM的190名外科医生中有138名（73%）至少在一个方面改变了他们的临床实践，44名（24%）知晓医院实践的变化，21名（11%）知晓同事实践的变化。外科实践发生变化的具体领域包括对深静脉血栓形成预防的关注（81名，44%）、同行间建设性讨论的增加（78名，42%）以及病例记录文件的质量（68名，37%）。所有群体都支持WAASM继续开展。医院管理人员和消费者建议将WAASM纳入认证范围。
外科医生、医院和消费者支持对外科护理进行独立同行评审的理念。他们证实了审计有能力影响和改变外科及医院实践。这强化了澳大利亚皇家外科学院将WAASM项目扩展至澳大利亚和新西兰全境的意图。
