1. Scottish Audit of Surgical Mortality Stirling, 8 th September 2005 a.m.thompson@dundee.ac.uk

2. SASM Completion of proformas (surgeon/ anaesthetist) First line assessment + Case Note Review Feedback

3. One way to do Case Note Review: Case Notes Arrive Set notes aside Keep notes safe Keep notes together Treat like a formal patient or legal opinion Identify time within the “next week” to do the case note review.

4. How to do Case Note Review: Quiet setting Allow adequate time (?1 hour) Adequate space No interruptions Skim through the notes to determine their layout (re-)organise the bits Pay particular attention to: Clinical notes (OP, ward, HDU/ITU) Operation note(s) Discharge summaries Nursing notes Integrated care pathways.

5. Actually Doing the Case Note Review: Read through the (re- ) organised case notes Make notes as you go Write/type/dictate a i.background, ii.a sequence of events, iii.learning points, iv.areas of good practice and v.deficiencies of care (if any)

6. Actually Doing the Case Note Review - Revision: Have I been thorough? Have I been concise (<1page A4)? Can I cite any evidence in support of my opinion? How have I phrased it/ would I be upset if I received this review? What are the deficiencies of care: the adverse events, areas of concern or for consideration? Would I be willing to sign this?

7. Future Considerations: Quality reviews Transparency How do we recompense assessors? Root Cause Analysis