Final Report > Chapter 7: The Audit and Monitoring of the Paediatric Cardiac Surgical Service in Bristol > How the clinicians in Bristol reviewed paediatric cardiac surgery > Meetings for audit and review of the PCS services
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Meetings for audit and review of the PCS services
29 The clinicians held a variety of meetings to discuss and review statistics relating to their clinical performance. These meetings fell into four main categories: Cardiac Surgical Audit; Departmental Audit; Clinico-Pathological Conferences; and Evening Meetings. They were held on a regular basis and variously attended by those involved in paediatric cardiac surgery and paediatric cardiology, and other clinical disciplines. Mr Wisheart stated: `The practice of audit within paediatric cardiac surgery was set up by the clinicians in that area and it was done on the basis of their interest, enthusiasm and commitment, not because of any management requirement.' [28]
30 Mr Wisheart explained that: `Cardiac Surgical Audit was formally instituted in
1990-91 in response to the White Paper. However it evolved from pre-existing activities which had been labelled educational but which did involve a significant element of audit.' [29] The meetings focused on the review of individual cases, although series of patients were reviewed when particular `topics' were audited, or annual statistics presented. Reviews of series of cases also took place with a view to presenting research findings to scientific meetings and publication in professional journals.
31 Regular departmental audit meetings, convened by the paediatric cardiologists and bringing together those involved in paediatric surgery and cardiology, commenced in 1990. These meetings were held monthly at the BRHSC and were open to all members of staff concerned with the care of children with congenital heart disease (CHD). Sometimes nursing staff and technical staff from the catheter laboratory attended. Mr Dhasmana stated: `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 the BRI.' [30] These particular meetings lapsed in 1992 for a period of time, as we shall explain in the subsequent chapters on concerns.
32 Clinico-pathological meetings were held when a patient died. These meetings were organised by Professor Berry and were scheduled to take place once a month. Mr Dhasmana stated that the aim of such meetings was to review individual cases: `in order to confirm the pre-operative diagnosis and to re-examine the operative procedure.' [31] Mr Wisheart told us that the meetings were open to cardiologists, surgeons, radiologists, and anaesthetists, as well as pathologists. He went on: `Up until the arrival of Dr Ashworth [32] in 1993 no record whatsoever was kept of these meetings and in particular there were no minutes or definitive reports of findings. As far as I am aware the occurrence of these meetings were [sic] not reported to the Trust Audit Committee.' [33]
33 Informal evening meetings were held at the homes of consultants beginning in the early to mid-1980s. Mr Wisheart described these as `multi-disciplinary evening meetings' and explained that they were attended `by cardiologists, surgeons, anaesthetists, radiologists and pathologists' [34] and took place two to four times a year. Mr Dhasmana referred to them as meetings of the `paediatric club'. [35]
34 Mr Wisheart stated that the agenda of these meetings: `... was not limited to audit, but it did include review of the annual statistical summaries and occasional series of patients, particularly before the more formal audit activities began in 1990-1991. The clinical series reviewed included Fallot's Tetralogy repair in 1991, VSD closure in 1988 or 89 and the prevention and management of pulmonary hypertension. [36] Thus the emphasis was on a series of patients rather than the individual patients.' [37] We were told that no minutes were taken of these meetings. As Dr Joffe told us: `We had a very small, close-knit group of five or six people and I think our thorough airing of the situation with a conclusion that we had come to at the end of it was sufficient for all of us to then take on whatever policy changes we had decided upon, and all of us would stick to them. So there was no problem in not having minutes for that kind of discussion.' [38]
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Footnotes
[28] WIT 0120 0392 Mr Wisheart
[29] WIT 0120 0392 Mr Wisheart
[30] WIT 0084 0020 Mr Dhasmana
[31] WIT 0084 0022 Mr Dhasmana
[32] [Dr Michael Ashworth, consultant paediatric pathologist, UBHT]
[33] WIT 0120 0395 Mr Wisheart
[34] WIT 0120 0396 Mr Wisheart
[35] WIT 0084 0023 Mr Dhasmana
[36] See Chapter 3 of Annex A for an explanation of these clinical terms
[37] WIT 0120 0396 Mr Wisheart