Private hospitals in NSW are refusing to take part in an annual audit of deaths after surgery, even though these account for up to one in five people who die in hospital each year.
The chairman of the Royal Australasian College of Surgeons, Guy Maddern, says it is time to ''shame'' the private hospitals into taking part, because the missing information means areas for improvement in patient care are not being identified.
Private hospital cases should be ''subjected to the same scrutiny and assessment as those treated within the public sector'', Professor Maddern said in his audit report.
''Private hospitals should wish to ensure that the standards they deliver are at the highest level; a national audit process would only benefit the hospitals and their patients.''
Private hospitals said they were unaware of the audit, which Professor Maddern dismissed as ''nonsense''. ''We've spoken to the large private hospital chains around the country about taking part in this audit and it would be strange to think their hospitals in some states are taking part and know about it while their NSW hospitals do not,'' Professor Maddern said.
Only five of nearly 90 private hospitals in NSW took part in the latest audit. Queensland was the only other state not to provide private hospital data, with no participants.
Professor Maddern said the gap represented about 20 per cent of surgical deaths in both states.
Western Australia had been auditing public and private hospitals longer than any other state, which Professor Maddern said had led to problem areas being identified, such as excessive resuscitation, the improvement of which had contributed to a ''significant'' reduction in surgical deaths.
''Not taking part in the audit is a hard position to defend. Cajoling private hospitals hasn't worked - we now have to shame them into it.''
Each death audited cost an average of $400 but that cost was borne in NSW by the Clinical Excellence Commission, said its chief executive Clifford Hughes. The commission is a statutory committee appointed to improve patient safety by the NSW Health Minister Jillian Skinner.
Private hospitals cited confidentiality as the primary reason for not providing information about surgical deaths, Professor Hughes said.
''While confidentiality should always be a priority, the processes the commission has in place are more than adequate to ensure confidentiality is maintained at the highest standards. This process is set up to educate surgeons so we can all learn from adverse situations and provide feedback on what can be done better. It is not about laying blame.''
But many private hospitals in NSW were unaware the national audit existed, the chief executive of the Australian Private Hospitals Association, Michael Roff, said.
''The other issue is that, because of the low number of private hospitals taking part, individual hospitals fear that they might be identified from the information given,'' he said. ''There was also concern about how the data would be reported, and about the amount of time that would need to be spent collecting the information.''
The director of the Centre for Clinical Governance Research, Jeffrey Braithwaite, said public hospitals were funded by taxpayers and therefore scrutiny was justified, but added: ''I think there is a strong case for making information available from both the public and private systems, because each does some things better than the other and sharing that information could improve outcomes in important health areas across the board.''