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Decision Making

@martinfarrier

Sure....

Im with you

....Not sure

need more info

Dont ask me

INTRO

Real (ish) example

To discuss

INTRO

SCHEDULE

1

Synopsis

2

Discuss

SCHEDULE

3

Decide

4

Conclude

SYNOPSIS

PATIENT 1

Elective Surgery

Not picked up from box 4

Odd pattern

STORY

STORY

Elderly Woman

Elective digit amputation

Day case

Warfarin - INR checked over a month ago

Pre-op Bloods done some weeks earlier

No major comorbidities

Operation is uneventful

Goes home later that day

No bleeding or concern

Routine analgesia

Foot bandage becomes blood soaked overnight

6 am patient gets up to go to toilet and faints.

Husband finds on the floor soon after

Ambulance called

Arrest in Ambulance (hypotension / tachycardia)

At arrival A/E resuscitation unsuccessful

SYNOPSIS

PATIENT 2

Routine Deaths Review

STORY

STORY

Elderly man

Known Bowel Cancer with mets

Resection and Radiotherapy

Currently on Chemo

Diverticular Disease

Attends with abdo pain / vomiting / distension

CT confirms Acute Intestinal Obstruction and ascites / liver mets / rectal mass.

Offered surgery and risks explained.

Surgery goes well and defunctioning colostomy performed.

Rectal mass confirmed = Tumour.

Post op HDU with good progress.

Day 6 faeculent fluid in abdominal drain.

Perforation of rectal stump with ischaemia and faeculent peritonitis.

Paliation provided

Was this a surgical complication / error?

Patient 1

CONCLUDE

Patient 2

Conclusion 1

PATIENT

1

Conclusion 2

PATIENT

2

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