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Irish surgical mortality audit remains stalled

A national audit that would aim to reduce surgical deaths has remained stalled since 2013, with RCSI President Mr Ken Mealy not expecting its commencement “any time soon”.

The initiative has been on hold within the National Office of Clinical Audit (NOCA) awaiting legal protection to ensure subjective peer-to-peer review of each death is confidential and privileged.

In an interview with the Medical Independent, Mr Mealy, formerly Clinical Director of NOCA, said most surgical deaths would not require an in-depth analysis. “But a small proportion do, and that peer-to-peer commentary, that subjective commentary, needs to be anonymised, and it needs to be privileged in the sense that it cannot be accessed.

“And currently, legally it is not privileged, as no audit process is privileged in Ireland and we got senior counsel opinion at that time, so we never set it up.”

It was hoped the Patient Safety Bill may introduce a protection. However, Mr Mealy said from drafts seen to date, “the definition of ‘clinical audit’ is so narrow it would not encompass peer-to-peer reviews and that subjective opinion; it would not, does not, include MDT meetings [on morbidity/mortality]”.

A Department of Health spokesperson said the Patient Safety Bill will legislate for exemptions from Freedom of Information legislation for records arising from clinical audit and for protections for these records from admissibility as evidence in civil proceedings. “These protections do not preclude the taking of disciplinary or regulatory proceedings through other routes,” according to the Department.

“Peer-to-peer commentary/reviews, multidisciplinary team meeting documentation on morbidity/mortality are not associated with clinical audit.”

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