Background
Summary:
- WAASM commenced on 1 June 2001 as a pilot project, under
the management of the University of Western Australia.
- In 2005 management of the project was transferred to the
College.
- The project is funded by the Western Australian Department
of Health (WADH)
- In November 2006, the WADH issued an operational directive
stating that all deaths that occur in public hospitals and licensed
private health care facilities providing services for public patients
are required to be classified and reviewed under the Western Australian
Review of Mortality (WARM). WARM came into effect on 1 January 2007.
Deaths that are reviewed under the WAASM process are exempt from the
WARM process.
- Similar projects are now running in most states including
South Australia (SAAPM), Tasmania (TASM), Victoria (VASM) and
Queensland (QASM). All audits function under the umbrella of the
Australian and New Zealand Audits of Surgical Mortality (ANZASM).
ANZASM, as an audit process, fulfils the following
criteria:
1) it is independent
2) it is external
3) it is peer-review
4) it is systematic
5) it is routine
6) it is objective
7) it is confidential (all audits are covered by qualified
privilege at
a Commonwealth level)
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
WAASM is a peer-review process.
Participation by consultant surgeons is a requirement of the
College’s CPD Program.
To start:
WAASM is notified of all deaths that occur in Western Australia
through The Open Patient Administration System (TOPAS). In the case of
private and smaller regional hospitals that are not linked into the
TOPAS system, WAASM is notified of all deaths directly by the medical
records department.
Next:
WAASM sends a Surgical Case Form to the consultant surgeon
linked to the case.
The Surgical Case Form is:
1) completed by the consultant surgeon or a registrar (under
supervision)
2) returned to WAASM in the envelope provided (as soon as
possible)
3) de-identified and sent to a first-line assessor (a
consultant surgeon; same speciality, different hospital) for anonymous
peer-review.
If a second-line assessment (case note review) is not requested
by the first-line assessor, the original surgeon will be sent written
feedback to this effect (and the case will be closed).
If a second-line assessment (case note review) is requested by
the first-line assessor (that is, insufficient information has been
provided on the Surgical Case Form or the case needs further
investigation) then these steps are followed:
1) A second-line assessor is chosen by WAASM staff based upon a
set of criteria created to minimise any selection bias.
2) Medical records are requested
3) The second-line assessor then reviews the Surgical Case Form;
the medical records; and the first-line assessor’s comment (comments
from first- line assessor are transcribed onto the second-line
assessors form), before writing a one-page report.
Note: The review is carried out and the report
written in a spirit of sympathetic enquiry, providing sufficient
details for a clear view of events.
4) The report and relevant feedback is sent to the original
surgeon. The case is then closed.
5) At each stage of the process the original surgeon has right
of reply.
Frequently Asked Questions
Do I have to participate in the WAASM?
Your participation in WAASM 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.
If I participate do I have to be a first or
second-line assessor?
You can choose to be a first-line assessor, and/or a
second-line assessor.
You can participate in the WAASM without being a first-line
assessor, and/or a second-line assessor.
Are instructions/guidelines provided for first and/or
second-line assessors?
Guidelines are sent with along with surgical proformas
forms.
An example of a second-line assessment report (1-2 page) is
also sent to you.
Is the WAASM process confidential?
All data and forms are de-identified. All data and
forms are securely stored. WAASM reports are covered by qualified
privilege.
How will WAASM know if a patient has died under my
care?
WAASM is notified of all deaths either through TOPAS or
medical records departments.
What if I need the medical records to fill out the
WAASM Surgical Case Form?
Contact the medical records department of your hospital
to ensure records can be located & delivered to you.
What do I do after completing the WAASM Surgical Case
Form?
Please return the Surgical Case Form to WAASM in the
envelope provided.
Contact us if you have
any questions or concerns.
Who do I contact if I have any queries?
Please contact WAASM Project Manager (Dr Diana Azzam).
The WAASM office can be contacted via phone on 08 6488 8691 or
via email.
Reports and Publications
Annual Reports
Consumer Booklet
Links
Contact
All general enquiries can be directed to:
WA Audit of Surgical Mortality (WAASM), M308
Room 110, Clinical Training & Education Centre
University of Western Australia
35 Stirling Highway, Crawley WA 6009
Phone: 08 6488 8691
Email: waasm@surgeon.org
Fax: 08 6488 8560
Clinical Director
Mr James Aitken
Project Manager
Dr Diana Azzam
Project Officer
Claire Findlater
Project Officer
Laura Halim
(pdf
10.3Mb)