Scottish model for surgical mortality used in Australasia

Editor—Two days before the BMJ published Baxter's editorial expressing doubts about whether the Scottish Audit of Surgical Mortality was applicable elsewhere,¹,² the Western Australian Audit of Surgical Mortality published its second annual report.³ The audit was based on the Scottish audit and started in 2001. It has already shown clear changes in local practice despite the different surgical environment. For example, unlike the NHS most surgical operations in Australia are performed in the private sector.

Current participation (96% of surgeons submitted 60% of all deaths) is not as complete as in Scotland because, unlike in Scotland, there is not an established culture of regional surgical audit. A particular problem at the outset was the highly aggressive medical legal environment in Australia. Qualified privilege was an essential prerequisite.

The principal area of public and media interest was the degree of surgeons' participation. The clear expectation is that surgeons participate in the audit process. Little attention was directed to the adverse events themselves.

The Royal Australasian College of Surgeons has announced its intention of establishing the Australian and New Zealand Audit of Surgical Mortality. This will be based on Western Australia's audit methods, which although now modified for local practice, retain the concepts of the Scottish audit at its core.