TU2: PEER REVIEW IN ORTHOPAEDIC ONCOLOGY

Abstract

Quality outcomes from medical intervention are assumed by patients & the community. However such quality cannot be assured in every case. There are systems which can be developed which will make the safety of patients more assured. In any system of medical care, it is presumed that the practitioners who are taking care of the patient are qualified both in their basic qualification & also in their higher qualification. As well it is now accepted that appropriate credentialling occurs & that this is the purview of the hospital which will check the qualifications & currency of practice with the medical board & the higher degree & currency (participation in CPD) with the College concerned. They should also review the privileges which define the scope of practice.

In orthopaedic oncology it is now essential that a practitioner has completed a higher form of training such as a Fellowship. At the current time in this country there is no process of assurance of the quality of the education program but there is continuing development in this area. Peer review & audit remains problematic. The RACS demands that surgeons participate in an appropriate audit process yearly & that this reviews outcomes rather than just complications. The participation is however voluntary. Despite this, the participation rate is greater than 94% of all surgeons. Medical boards have been requested to make participation in a quality CPD program compulsory, but have not done so, & there are no sanctions for non participation – yet.

Most surgeons participate in regular morbidity & mortality meetings, but these are not truly audits of outcome. It would be wise for the Australian Sarcoma Group to develop outcome measures which could easily be collected. The desire to perform research should not be confused with audit which simply addresses quality at an appropriate expert level and which the community expects. Prospective collection & review of outcome measures will mean that trends in performance will be noted earlier. This is particularly important in adverse events.

These processes have been embraced by some branches of surgery more than others. Medical outcome reviews of performance have not been developed to such an extent in most disciplines for a variety of reasons, including the fact that surgical endpoints can be more easily identified. The same principles apply, however. It is important for the profession to participate in self audit or third parties will demand it, not necessarily in a way which we might prefer.