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Title: Detection of adverse events in surgery by record review
Author: Olsen, Sisse Bjorn
ISNI:       0000 0004 2737 4184
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2006
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Surgery has a strong tradition of professional self-assessment which has developed into the current practice of auditing specific elements of care and outcome. Despite the growing recognition of error it has been difficult to engage individual clinicians in measurement and analysis of error in their own practice. The different methods for identifying adverse events and critical incidents in hospital care each have their own strengths and limitations. Record review has become the internationally recognised gold-standard for detecting and assessing the incidence of adverse events in hospital care to address patient safety. This thesis describes the development of a method of detecting adverse events and also critical incidents which build on the surgical tradition of peer assessment and audit; it therefore includes surgeons in the data collection. It is an adaptation of traditional retrospective record review. A series of studies were undertaken to develop and test this methodology in different settings. The initial study tested the methodology reviewing 134 case records at the time of discharge from three surgical units involving both nurses and doctors involved in the care and using a structured review tool. The findings of record review of 288 medical and surgical patients were compared with findings of incident reporting and active surveillance of medication errors. In addition a training programme in record review for clinicians was developed and tested. The work of this thesis also led to some indirect outputs interns of use of the training program and capacity for supervision of record review projects. This research concludes that real-time record review by surgeons is feasible and supplies results which are both trusted locally and can lead to change in the delivery of surgical care. Training in record review is essential to Improve the validity and reliability of results.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available