A survey of perioperative clinician’s knowledge and application of the law regarding the classification of deaths in the perioperative period

Abstract

Background: Doctors complete death notification forms poorly, in South Africa and globally. This reduces accuracy of mortality statistics in South Africa, which is needed by policymakers and clinicians to focus on healthcare improvement initiatives. The law on procedure-related deaths was changed in 2008, directly informing on the practice of anaesthesiologists. Perioperative deaths continue to be misclassified, possibly related to doctors’ lack of knowledge or understanding of the law. This study aimed to determine if perioperative clinicians working in theatre and the Intensive Care Unit (ICU) knew and understood the law pertaining to deaths in the perioperative period. Method: A survey was conducted at eight hospitals in the Durban area amongst specialists and non-specialists who work in theatre and ICU. The questionnaire had three parts: definitions, medico-legal experiences and clinical scenarios. Results: Eighty responses were received, a response rate of 74%. More non-specialists responded (57%). When undecided on how to classify a death, clinicians mostly seek assistance from their private medico-legal insurance or a senior colleague. However, specialists are unable to define or classify unnatural and procedure-related deaths any better than non-specialists. Conclusion: Specialist and non-specialist knowledge and application of the law relating to unnatural deaths in the perioperative period is poor. Forensic pathologist assistance is underutilised. More needs be done to empower doctors on medico-legal issues affecting perioperative clinical practice.