Overview
Board of Surgical Research
ASERNIP-S
Audits of Surgical Mortality
Queensland Audit of Surgical Mortality
South Australian Audit of Perioperative Mortality
Tasmanian Audit of Surgical Mortality
Victorian Audit of Surgical Mortality
Western Australian Audit of Surgical Mortality
Australian Capital Territory Audit of Surgical Mortality
Northern Territory Audit of Surgical Mortality
Collaborative Hospitals Audit of Surgical Mortality
Morbidity audits
Simulated surgical skills program
Logbooks
Research and travel scholarships
Academic Surgery

Victorian Audit of Surgical Mortality

Background
Qualified Privilege
Audit Process
FAQ
Reports and Publications
Contact

Background

The Victorian Audit of Surgical Mortality (VASM) seeks to review all deaths associated with surgical care.

VASM is a collaboration between the Victorian Government’s Department of Health, the Victorian Surgical Consultative Council and the Royal Australasian College of Surgeons. The VASM project is funded by the Victorian Department of Health. The College manages VASM through the Melbourne head office.

All surgery carries some risk and it is an unfortunate reality that sometimes patients do not survive surgery, or die after having a surgical procedure. The majority of these deaths are not preventable and occur despite surgery to overcome a life threatening condition. In some instances however death is an unexpected outcome of surgery for a condition that is not life threatening. It is especially important that the issues surrounding death in the latter group are studied to see if similar adverse outcomes can be prevented.

Clinical Audit

Clinical audit is a regular, documented, critical analysis of the outcomes of (surgical) care. It is accepted as an essential component of the evidence-base that underpins the practice of surgery. The original mortality audit was established in Scotland (Scottish Audit of Surgical Mortality). The template was adapted for the Australian environment and in 2001 gave rise to the West Australian Audit of Surgical Mortality. The Victorian Audit of Surgical Mortality (VASM) is based on the experiences of this and several other states.

This audit process is designed to gather information on factors involved in the death of patients undergoing surgical treatment. Gathering information from multiple sources over time will allow us to detect emerging trends in the outcomes from surgical care. The aim is to identify any system or process errors and develop strategies to redress these.

All information collected during the audit process is protected by Commonwealth Qualified Privilege legislation. It is therefore not possible to provide reports on individual instances of mortality to hospitals or families of deceased persons.

An annual report providing a summary of findings on all deaths will be published and be available to the general public.

ANZASM Qualified Privilege

Overview

The qualified privilege declaration has been designed to encourage surgeon participation within the mortality audits by strictly protecting the confidentiality of information gained in the audit.

Via a blend of state and commonwealth legislation, the declaration prevents third parties from using surgical reports for purposes that could potentially be to the detriment of the surgeon in question.

The qualified privilege declaration allows non-identifiable data to be used in reviewing and analysing surgical procedures, while information which may identify an individual requires the expressed approval of the individual being recognised.

With state and commonwealth authority, the declaration effectively allows surgeons to confidently participate in the mortality audits, knowing information they liberally divulge will be utilised exclusively for its designed professional development purpose and nothing else.

Details

The Royal Australasian College of Surgeons has received approval from the Minister of Health and Ageing to declare the Australian and New Zealand Audit of Surgical Mortality (ANZASM) a ‘quality assurance’ activity under the Commonwealth Qualified Privilege (QP) scheme.

Qualified privilege declarations are intended to encourage participation of surgeons by protecting the confidentiality of information created as part of this activity.

ANZASM is a bi-national framework of regionally based audits of surgical mortality. As of July 2007, every state in Australia has its own audit. Although regionally based, all audits are covered by an over-arching QP protection that ANZASM has obtained at the national level. In some regions, state coverage is also held.

This document explains;
1) how the national QP legislation imposes responsibilities for legal disclosure of audit-related information on both the regional audits and their related audit staff.
2) what information the regional audit is permitted to disclose to hospitals (in relation to the Commonwealth QP scheme).
3) what information the regional audit is not permitted to disclose to hospital (in relation to the Commonwealth QP scheme).

The regional surgical mortality audits ARE permitted to:

Provide annual state and hospital reports that contain aggregated, de-identified (with respect to surgeon and patient) data that will report on the following:

audit participation rates for their surgeons (exception: hospitals with consultant numbers less than two).
hospital specific rates of optimal or suboptimal care of patients as compared to state and national averages.
information about the general quality of surgical care being undertaken at that hospital, relating to all aspects of care during a surgical admission

The regional surgical mortality audits ARE NOT permitted to:

disclose confidential information gained from audit activities to anyone other than the surgeon involved in the case or the surgeons specifically assigned to provide a peer review assessment of the case. A person who discloses information stemming from the declared activity either indirectly or directly to another person or a court of law faces a possible penalty of up to 2 years imprisonment (Section 124Y, Health Insurance Act 1973)

Important:

Providing audit information to:

Chief Executive Officers, or
Surgical/Medical/Clinical Directors,

At hospitals where the surgeon is practicing is not permitted by law.
However, the federal Minister of Health may authorise disclosure of information that relates to a serious offence against a law-in-force in any State or Territory.
This means:

identifying information can only be disclosed with the express approval of the identified individuals.
the release of any such information would be unusual and should only occur after the implications of disclosure are properly considered.

Participating surgeons in the audit ARE permitted to do the following:

identify other practitioners involved in the case.

Further information about the QP scheme and how it relates to ANZASM is available from the ANZASM central office in the College Research, Audit and Academic Surgery Division, PO Box 553, Stepney SA 5069 (Tele: (08) 8363 7513)

Please note:
Information provided in this qualified privilege guide, has been complied in partnership with Russell Kennedy lawyers.

Audit Process

VASM is a peer-review process. Participation by consultant surgeons is a requirement of the College’s CPD Program. The audit process is initiated by notification of the death of a patient while under surgical care.
The following procedure is followed:

The VASM office will send a case record form to the (treating) surgeon responsible for the care of that patient and invite them to participate in the audit
Completed case record forms are returned to the VASM office
All identifying information is removed from the form
The case record form is then sent to another consultant surgeon (first-line assessor) of the same specialty but from a different hospital, for (anonymous) peer-review
The assessor gives their opinion as to the adequacy and appropriateness of management of the patient and whether the case would benefit from a more detailed review
If no further review is felt necessary, the treating surgeon will receive feedback to this effect and the case will be closed
If a more detailed review is requested or if the surgical assessor considers that insufficient information to reach a conclusion was provided on the original case record form, a more detailed review of the case will be initiated (second-line assessment)
For this second line assessment a copy the patient’s case-record is required. VASM will forward the original case record form with the case-notes to another consultant surgeon from the same specialty, but in a different hospital for a written review
When complete, the outcome of this review will then be fed back to the (treating) surgeon responsible for patient care

Frequently Asked Questions

Q. Do I have to participate in VASM?
A. Your participation in VASM is a requirement if you are a surgeon in an operative based practice, have a surgical death and
an audit of surgical mortality is available in your hospital.

Q. If I choose to participate in VASM, do I have to be a first or second-line assessor?
A. No. All surgeons participating in the audit can volunteer to be either first- or second-line assessors.

Q. Are any instructions/guidelines provided to those who volunteer to be first or second-line assessors?
A. Yes, a ‘Guideline for Assessors’ is provided. This document suggests the principles to adopt for the peer review assessment and includes examples. Also provided is a first- or second-line assessment form for the assessor to complete.

Q. Is the VASM process confidential?
A. Yes. All data is de-identified and is securely stored at the VASM office.

Q. How will VASM know if a patient has died under my care?
A. VASM will be notified by the hospital’s medical records department. Alternatively, surgeons may notify VASM directly of a death of a patient under their care.

Q. What if I require the medical case notes to fill out the VASM case record form, is there as easy way for me to retrieve them?
A. Yes. The medical records department of each hospital will locate medical records for you.

Q. What do I do once I have completed the VASM case record form?
A. Once you have completed the case record form, please return it to VASM’s dedicated PO Box in the reply paid envelope provided.