Affiliations: Department of Public Health Sciences, St. George's Hospital Medical School, London, UK Fax: +44 20 8725 3584; E‐mail: j.poloniecki@sghms.ac.uk | Department of Medical and Healthcare Education, St. George's Hospital Medical School, London, UK
Note: [] Corresponding author.
Abstract: At present hospitals keep poor records of the number of patients who die on the premises. Monitoring of runs of deaths amongst the patients of individual surgeons, or other practitioners, is generally absent, or it is informal and erratic. Such up‐to‐date information as is available in a hospital is generally not used to calculate the risk of dying from major surgery and hence provide patients offered surgery with an opportunity, if they so wish, to weigh the risk before accepting. Two examples are provided to show how deaths may be avoided when there is monitoring. One example shows how failing to monitor allows an increase in the number of deaths to go undetected, and uncorrected. The second example shows how calculating the risk may result in patients being treated elsewhere, and lives saved in consequence. The legal framework encouraging monitoring is described; but evidently existing law has not caused hospitals to introduce the formal procedures that could save lives. The reasons for this are a lack of precision in the legal wording, lack of specific penalties, lack of enforcement, and placing the onus on the doctor, rather than on the hospital's management. New legislation is proposed.
Keywords: Performance monitoring, CRAM chart, risk estimation, surgical deaths, health and safety, Health Act 1999 Section 18(1), medical negligence, coroner
