Summary and Recommendations

SASM is now established as a regular professional activity supported by Consultants, Royal Colleges, CRAG and purchasers

. Over 95% of consultant surgeons and anaesthetists in Scotland participate

   More than 90% of deaths on surgical units undergo the full process of peer review audit

  85% of consultants, responding to a postal questionnaire, expressed the view that SASM should continue.

The increasing involvement of both consultant surgeons and anaesthetists in ASA 4/5 patients is encouraging, since previous reports identified this as an area of concern

. Consultant involvement in the management of ASA 4/5 patients should be routine.

Previous SASM recommendations are being implemented

  Post graduate clinical skills courses are now mandatory in surgical training

  The Royal College of Surgeons, Edinburgh is organising a symposium on anastomotic leakage during 1997

   The Royal Colleges have prioritised the problem areas of pre and post operative care of the critically ill

  Universities are encouraged to prioritise the management of high risk patients in undergraduate curricula

  SASM will examine anastomotic leakage in more detail in 1997.

Assessors continue to identify problems in the provision and utilisation of HDU and ITU care

 . 4 - 5% of patients not receiving intensive care could have benefited from it · Major operations in high risk patients continue to     be performed in hospitals with no HDU/ITU facilities

  Deficiencies in medical and nursing care indicate the need for improvement in staff numbers and training

  These findings are supported by the Aberdeen audit of availability of ITU/HDU care

   There is a need for a national quality assurance programme

  1997 SASM forms will seek more detailed information on the use of intensive care.

The problem of DVT, highlighted last year, has been further addressed with the publication of SIGN guidelines. The continuing development of guidelines is strongly supported. SIGN should give high priority to the following areas:-

   Preparation for surgery

   Resuscitation and monitoring of the critically ill, before, during and after surgery.