Building a framework for trust: critical event analysis of deaths in surgical care

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Abstract
Introduction Events over recent years have undermined patients' and society's trust in clinicians and healthcare institutions. For clinicians to restore and retain public confidence, they need to show that effective mechanisms exist for assessing events such as death and to justify patients' faith in the delivery of care.1 In the high profile world of cardiac surgery, the audited results of key elective procedures may be sufficient to restore confidence.2 In wider surgical practice, simple death rates are unlikely to be sufficient; case-mix (particularly for emergency admissions), institutional, and national issues can jeopardise the interests of high risk patients.3 Any critical incident review by peers working in the same speciality or subspecialty of patients who die under surgical care should take into account the nature of the patient and the circumstances of admission. In Scotland, the Scottish Audit of Surgical Mortality (SASM) is a national system of peer review of deaths that occur under surgical care that has been in place since 1994.4 Full details of how SASM works, and the annual reports, are on its website (http://www.sasm.org.uk/).