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The purpose of this study is to measure the adverse event rates for five elective surgical procedures: transurethral resection of prostate, cholecystectomy, hysterectomy, joint arthroplasty, and herniorrhaphy.

A retrospective two‐stage medical record review was conducted on 1,177 admissions in 1998 and 2000 at two tertiary hospitals. Records found to be positive for any of 17 screening criteria during the first stage were reviewed by surgeons from the relevant specialty for adverse events associated with the admissions.

The adverse event (AE) rate overall was 23.1 per cent. There were large variations between the procedural groups, ranging from 12.7 per cent (laparoscopic cholecystectomy) to 44.8 per cent (abdominal hysterectomy). Of the 272 AEs, 89 (32.7 per cent) had an unplanned readmission requiring 709 additional days in hospital and 55 (20.2 per cent) patients had additional surgery (seven returned to theatre during their admission for the procedure). AEs involving a disability that resolved within 12 months occurred for 91.2 per cent, 6.3 per cent had permanent disability, and 2.5 per cent resulted in death. The surgical reviewers determined that 24.7 per cent of the AEs were highly preventable.

The study confirms that surgical admissions have a high risk for AEs. The risk varies between procedural groups and 47.3 per cent are not preventable. Adverse events are an important patient safety issue. Preventing AEs would reduce readmissions, patient discomfort and associated costs. Routine monitoring of AEs is recommended.

The purpose of the paper is to measure compliance with agreed protocols for prophylactic antibiotics for five elective procedures: transurethral resection of the prostate, cholecystectomy, hysterectomy, joint arthroplasty and herniorrhaphy in two teaching hospitals.

Compliance was measured during the pre and post intervention periods by reviewing medical records.

Overall, compliance improved by 18 per cent (95 per cent CI: 12 per cent, 23 per cent) with greater improvements for transurethral resection of the prostate and hysterectomy, increasing by 27 per cent (95 per cent CI: 14 per cent, 40 per cent) and 24 per cent (95 per cent CI: 16 per cent, 32 per cent) respectively. Compliance remained low for cholecystectomy (17 per cent) and hysterectomy (25 per cent). Overall, the proportion of patients not receiving any prophylaxis where its use was indicated, declined by 6 per cent (95 per cent CI: 1 per cent, 11 per cent) from 23 per cent. The use of additional anti‐microbials that were not recommended in the protocol was high for joint arthroplasty 65 per cent and hysterectomy 71 per cent, but overall this practice declined by 8 per cent (95 per cent CI: 3 per cent, 14 per cent). Costs were reduced from $11.72 to $10.53 per patient between the pre and post intervention groups, while a complete adoption of the protocols could reduce costs by 70 per cent to $3.40. There were large variations in correct dosages and timing of antibiotics between procedural groups.

Although compliance improved there were large differences between the specialties. The adoption of preventive strategies is fundamental to providing safe patient care. The use of inappropriate antimicrobials is also an important patient safety issue that contributes to antibiotic resistance and is associated with increased costs. Introducing change in health organizations is difficult and the factors influencing successful change strategies require further study.

The paper measures and improves compliance with agreed protocols in health care intervention procedures.

THIS is the month when librarians and library workers everywhere, their holidays over, turn to their winter plans. There are, however, some interesting events to take place before the darker and more active months come. The first is the meeting at Oxford on September 21st and subsequent days of the Federation International de Documentation. This will be followed by and merge into the ASLIB Conference, and there is in prospect an attendance of over three hundred. Our readers know that this organization produces and advocates the International Decimal Classification. It is not primarily a “library” society but rather one of abstractors and indexers of material, but it is closely akin, and we hope that English librarianship will be well represented. Then there is a quite important joint‐conference at Lincoln of the Northern Branches of the Library Association on September 30th— October 3rd, which we see is to be opened by the President of the Library Association. Finally the London and Home Counties Branch are to confer at Folkestone from October 14th to 16th, and here, the programme includes Messrs. Jast, Savage, McColvin, Wilks, Carter, and the President will also attend. There are other meetings, and if the question is asked: do not librarians have too many meetings ? we suppose the answer to be that the Association is now so large that local conferences become desirable. One suggestion, that has frequently been made, we repeat. The Library Association should delegate a certain definite problem to each of its branches, asking for a report. These reports should form the basis of the Annual Conference. It is worthy of more consideration.

SEPTEMBER, by a traditional impulse, has always represented to some minds the beginning of the most active period in the library year. This year the month that sees the close of the holiday season, the shortening day and lengthening evening, holds fairer promises and greater difficulties than any in the past six years or perhaps in the past twenty‐five. It sees large programmes in prospect but many fences to be surmounted and, if the physicists are right, the beginning of a new era. It is doubtful if, in so short a space of time as that which has elapsed since we last wrote, so many important events have occurred. The entirely new political alignment may have its effects on our post‐war policy. We hope the library will never again be the protege of a political party because that means that it becomes thereby the target of the opposition—as was the case when in London a change of party in local government brought about the wreck for a generation of at least one library service which had the misfortune to have been initiated by the other party. We have however, no immediate apprehensions about public libraries in present circumstances.

THE new library building has been open for six months now. It is pleasantly situated in an area of new buildings, and occupies a prominent island site just on the edge of the shopping centre. The old library was in the middle of a shopping area, and it has been interesting to note that our removal from that site has had a more considerable effect on the traffic pattern than one would have thought.

Patient safety and medical error have become prominent issues following publication of Institute of Medicine reports in the USA. The USA, Australia, and now Canada have followed a national “medical error” studies path that uses language rejected by the interdisciplinary group of experts described previously in this column, and continues using methods considered seriously flawed as well as incomplete by noteworthy hospital epidemiologists. Preliminary review of British hospitals by similar methods also has been published. Proven and more cost‐effective surveillance methods are pertinent methods developed over the past several decades by hospital epidemiology and infection control professionals who have more experience, but this heritage has been ignored in recent patient safety juggernauts. It is time to question why retrospective physician chart review approaches remain in vogue with national bodies to enumerate adverse patient outcomes and attribute them with “medical error” when better alternatives exist.

The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically.

In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis.

Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue.

Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives.

The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.