Post-mortem general surgeon reflection on decision-making: a mixed-methods study of mortality audit data.

Abstract

Surgical deaths in Australia require the treating surgeon to document the event via a standard report. A section of this report invites surgeons to reflect on changes to management they would initiate in retrospect. This study analyses these reflective statements and categorizes them in an effort to gain insight into reflective learning. This audit-based cross-sectional study involves patients who died in-hospital under the care of general surgeons in Queensland, Australia, between July 2007 and December 2016. Retrospective surgeon statements were analysed using both quantitative and qualitative methods. Of the 2575 surgeons, 459 (18%) indicated they would manage their patient differently in retrospect. Half of these statements (46%) concerned changes to an operative decision. Of this group, most of these concerned either the decision to operate or not (26%), what operation to perform (32%) or earlier timing of surgery (32%). Overall, one-third of statements (29%) concerned retrospective changes to clinical decisions not related to operative management. Communication considerations, ceiling of care decisions and technical operative changes made up smaller proportions of statements. This mixed-methods study has identified a minority of surgeons proffer retrospective management changes after their patient has died. Of those who do, decision-making around operative management is the most common area of reflective consideration.