Overview
Board of Surgical Research
ASERNIP-S
Audits of Surgical Mortality
Collaborative Hospitals Audit of Surgical Mortality
Queensland Audit of Surgical Mortality
Victorian Audit of Surgical Mortality
Western Australian Audit of Surgical Mortality
Morbidity audits
Logbooks
Research & Travel Scholarships
Academic Surgery

Victorian Audit of Surgical Mortality

Background
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 Human Services, the Victorian Surgical Consultative Council and the Royal Australasian College of Surgeons. The VASM project is funded by the Victorian Department of Human Services. 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.

Audit Process

VASM is a peer-review process. Participation by surgeons is voluntary. 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. No. Surgeon participation in VASM is currently voluntary.

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.