Annex A > Chapter 18 - Medical and Clinical Audit > The audit and review of the paediatric cardiac surgical services in Bristol > Audit meetings, paediatric cardiac surgery and paediatric cardiology
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Audit meetings, paediatric cardiac surgery and paediatric cardiology
422 Regular audit meetings, bringing together those involved in paediatric cardiac surgery and paediatric cardiology, commenced in 1990. Dr Robin Martin, consultant paediatric cardiologist since 1989, was the co-ordinator of these meetings. He explained in his letter of 18 December 1989 to colleagues:
`At a recent meeting it was suggested we ought to hold regular clinical audit meetings and I have volunteered to help co-ordinate these. The purpose of these meetings would be to discuss clinical cases, complications, post-operative management and other relevant problems in the Paediatric Cardiology and Cardiac Surgery Unit.' [504]
423 Mr Dhasmana stated that the meetings were held monthly, initially on Monday mornings, but later (from 1992) on Wednesday lunchtime or in the early afternoon, in the seminar room attached to the cardiac catheter laboratory at the BRHSC. [505]
424 As to attendance at these meetings, Mr Dhasmana stated:
`The meeting was open to all members of staff concerned with the care of children with congenital heart defects ... However this was mostly attended by members of paediatric cardiac medical and surgical staff and also by nursing and technical staff from the catheter lab. Dr Peter Wilde the consultant cardiac radiologist and/or his staff and Mrs Helen Vegoda from the paediatric cardiac family support services also attended these meetings from time to time. Others like anaesthetists and junior members of surgical staff were not able to attend these meetings on a regular basis because of their clinical commitment elsewhere in the same hospital or at BRI.' [506]
425 Dr Bolsin told the Inquiry that it was `probably' right that anaesthetists were invited to and did on occasions come to these meetings, but that there were difficulties in attending. [507] Dr Masey told the Inquiry that, because of timetabling difficulties: `We did not find that we were able to frequently meet with our surgical colleagues.' [508]
426 There was evidence that these meetings had lapsed before the beginning of 1992. Dr Martin wrote to Dr Jordan on 3 January 1992: `I think it is very important that we recommence our audit sessions in 1992 and after discussion I think we ought to hold these monthly on the fourth Wednesday of each month. ...' [509]
427 Dr Martin commented on the lapse of these meetings:
I think it is difficult in a busy clinical programme sometimes making the time to get people to come to these meetings ... That is not to say that people were not interested, it is just the pressure of clinical commitments often makes it very difficult ... it was the hurly-burly of clinical work that makes it much more difficult and I am sure it was a problem more clinicians face, to get a regular audit programme going is very difficult ... I think it is probably fair to say the switch [split] site arrangement did not particularly help us to get an adequate number of people together. ... Since they moved the open heart surgery up to the Children's Hospital, we have got more people on site and it has been easier to get good consensus and a group of people together, but it is not easy.' [510]
428 These meetings lapsed again during 1992. Mr Wisheart stated that: `Following the publication of the contents of a paediatric cardiological audit in "Private Eye", this audit programme lapsed for a time.' [511] Mr Dhasmana stated that: `... the confidentiality of the data was broken at least on two occasions, when figures relating to Tetralogy of Fallot and Arterial Switches appeared in the media ("Private Eye" 1992). This did have some negative effect on the conduct of these meetings.' [512]
429 A number of witnesses commented on the specific effect of the publication in `Private Eye' on 3 July 1992 of an article concerning data about paediatric cardiac surgery in Bristol. [513]
430 Mr Dhasmana told the Inquiry that following the publication of the article: `... I felt the best thing would be really to explain myself to my medical colleagues ... so I was continuing with my audit in a similar manner ... it did not stop me from presenting our data to the department or monthly audit or anything like that.' [514]
431 Dr Joffe commented in the following exchange:
`Q. Mr Wisheart, when he spoke to the GMC, said that the effect of the "Private Eye" article ... [was] that the audit process of paediatric cardiology was very seriously set back, and really did not occur thereafter for quite some time ... How accurate is that?
`A. I think it is accurate in the sense that the audit process that Dr Martin had developed at the end of the year before and during that year 1992 was to a degree certainly interrupted by the reaction to the "Private Eye" article. There were meetings I believe, but they did not follow the same format as the previous ones.' [515]
`Around that time - I think it was around July or August 1992 - we were quite concerned about a report that appeared in "Private Eye" at that stage which seemed, appeared to include what appeared to be data from our audit meeting directly. I am sure it had an effect on audits after that, certainly for the surgical results. I think we carried on having some audit sessions for individual catheters, maybe foetal, you know some of the different sub-specialties that we also feel important to audit, but I do not remember that same format being used for the surgical results. ...' [516]
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Footnotes
[504] WIT 0084 0035; letter from Dr Martin to colleagues dated 18 December 1989. Mr Dhasmana refers to these meetings as `monthly paediatric cardiology/cardiac surgery audit meetings'(see WIT 0084 0019), but Dr Martin's letter is headed `Departmental Audit Meetings'
[505] WIT 0084 0019 Mr Dhasmana
[506] WIT 0084 0020 Mr Dhasmana
[509] UBHT 0061 0153; letter from Dr Martin to Dr Jordan dated 3 January 1992. Mr Wisheart confirmed that although the letter is headed `audit of paediatric cardiology' it was referring to audit which embraced both paediatric cardiology and paediatric cardiac surgery, see T41 p.75
[511] WIT 0120 0393 Mr Wisheart
[512] WIT 0084 0020 Mr Dhasmana
[513] SLD 0005 0002; `Private Eye' 3 July 1992