Fallout

In our medical center every patient who comes in on the surgical service has their chart reviewed as part of quality assurance. If there is a complication, it is recorded and categorized and entered into a data base. These complications can be wound infections, extended hospital stays, nosocomial infections, bleeds, etc. This database is constantly under analysis. Whenever there is a bump where the number of complications excedes the set levels that are determined nationally, it is said to fallout. Somethings such as an operative death or post operative death automatically fall out. So do all major complications. When something falls out, it is sent to be reviewed. Complications are kept per procedure, per patient, per unit etc.

This week was rough. One of our physicians "fellout". That is to say, he had more complications that his peers and those nationally. When this happens, all his complications are immediately sent for review. In this review, we inspect to check for clinical decision making, technical competence, wisdom and knowledge base. Many times the review finds that the particular surgeon just happened to be on call when bad things happen such as dead bowel from mesentaric ischemia or STEMIs with right main disease. This week the review brought out more questions than answers. So, I had to suspend the doc pending further investigation.

I have heard all these attorneys say the problem is that we physicans do not police ourselves. In fact we will stop a doctor from practicing while we investigate to be sure patients are not harmed. It is all part of the bylaws that you practice in the hospital. Do attorneys suspend each other from practicing while they investigate their competence?