Last Update: 18/04/2012 13:15
Background
Qualified privilege
Audit process
Frequently asked
questions
Electronic
platform - Fellows interface
Reports and
publications
Seminars
Contact
Background
The ACT Audit of Surgical Mortality (ACTASM) is an audit process
that provides an independent, external peer review, which is
systematic, objective and confidential. The purpose of ACTASM is to
review all deaths that occur during an episode of surgical care and
to provide opportunities for improvements in patient outcomes.
ACTASM is an important initiative of the Royal Australasian
College of Surgeons and is modelled on the successful
Australian New Zealand Audit of Surgical Mortality (ANZASM).
ACTASM is funded by ACT Health to provide the audit process to all
public and private locations in the ACT under Commonwealth
Qualified Privilege. The ACTASM Management Committee
meets quarterly and oversees the project which constitutes an
invaluable foundation to the running and success of the audit
program.
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.
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
detection of system issues and emerging trends.
The aim is to develop strategies to redress these through
feedback to individual surgeons and through aggregate data, which
is disseminated to all surgeons, hospitals and Departments of
Health.
Qualified privilege
Overview
The Qualified Privilege (QP) declaration encourages 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 QP declaration allows non-identifiable data to be used in
reviewing and analysing surgical procedures, while information that
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 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 QP
scheme.
QP declarations 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:
- how the national QP legislation imposes responsibilities for
legal disclosure of audit-related information on both the regional
audits and their related audit staff
- what information the regional audit is permitted to disclose to
hospitals (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, to provide 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 identify
other practitioners involved in the case.
Please note,
ANZASM in partnership with Russell Kennedy lawyers compiled the
QP guide. For further information about the QP scheme contact
ANZASM.
Audit
process
ACTASM is a peer-review process. Participation by consultant
surgeons is a requirement of the College's Continuing Professional
Development (CPD) Program.
Participation
According to the Royal Australasian College of Surgeons'
Continuing Professional Development Manual 2010-12, it is "a
requirement to participate in the Australian and New Zealand Audit
of Surgical Mortality if a surgeon is in operative based practice,
has a surgical death and an audit of surgical mortality is
available in the surgeon's hospital."
- Participation as an assessee may be required.
- Participation as an assessor remains voluntary and highly
recommended.
Steps
Notification of cases
The hospital notifies ACTASM of all deaths that occurred during
a surgical admission.
ACTASM sends a Surgical Case Form to the treating surgeon linked
to the case. The treating surgeon or a registrar (under
supervision) completes the form and returns it to ACTASM (at each
stage of the process the treating surgeon has right of
reply).
Note: If the case does not fit the inclusion criteria for the
audit, it can be excluded at this point and the case is closed.
First line assessment
ACTASM sends de-identified information to a first-line assessor
(consultant surgeon, same speciality) for anonymous
peer-review.
The first line assessor reviews the case and returns their
professional assessment to ACTASM. As part of the review process,
the assessor will identify if there was sufficient information to
make an accurate review, if there are any areas that require
further review and offer feedback on the case.
If there was sufficient information and there were no areas for
further review, ACTASM staff send the written feedback to the
treating surgeon (at each stage of the process the treating surgeon
has right of reply) and the case will be closed.
Second line assessment
If there was insufficient information or further review was
requested:
- ACTASM project staff request the medical records.
- The hospital provides the medical records.
- ACTASM project staff send the de-identified records to a
second-line assessor (consultant surgeon, same speciality).
- The second-line assessor reviews the Surgical Case Form and the
medical records and completes a one-page report.
Note: This is undertaken in the spirit of sympathetic enquiry and
must provide sufficient details for a clear view of events.
- The second-line assessor returns all of the documentation to
ACTASM.
- ACTASM will send the report and feedback directly to the
treating surgeon (at each stage of the process the treating surgeon
has right of reply) and the case will be closed.
At each stage of the process the treating surgeon has right of
reply.
Frequently asked
questions
Do I have to participate in the ACT Audit of Surgical
Mortality?
According to the Royal Australasian College of Surgeons' Continuing
Development Program, it is "a requirement to participate in the
Australian and New Zealand Audit of Surgical Mortality if a surgeon
is in operative based practice, has a surgical death and an audit
of surgical mortality is available in the surgeon's
hospital."
Therefore, under those conditions participation is compulsory.
Participation as an assessor remains voluntary, but is highly
recommended.
Do I have to be a first or second-line
assessor?
No. All surgeons participating in the audit can volunteer to be
either first- or second-line assessors. There are some point
incentives to encourage participation, which will increase in
amount in 2010.
Are any instructions/guidelines provided for first or
second-line assessors?
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.
Is the ACTASM process confidential?
Yes. All data is de-identified and is securely stored at the ACTASM
office. ACTASM reports are covered by qualified privilege.
How will ACTASM know if a patient has died under my
care?
The hospital's medical records department notify ACTASM of all
surgical deaths. Alternatively, surgeons may notify ACTASM directly
of a death of a patient under their care.
What if I require the medical case notes to fill out the
ACTASM case record form, is there as easy way for me to retrieve
them?
Yes. The medical records department of each hospital will locate
medical records for you.
What do I do after completing the Surgical Case
Form?
Please return the Surgical Case Form to ACTASM in the reply paid
envelope provided. Contact us if you have
any questions or concerns.
Who do I contact if I have any queries?
Please contact the ACTASM Project
Manager.
Electronic
platform - Fellows interface
ANZASM now offers an electronic submissions platform called Fellows
interface. The paper-based submission format is still current
and available. The new interface allows Fellows to complete and
transmit surgical case and first-line assessment forms securely
online.
The Fellows interface is an "either/or option"; you
can only use the online or paper system. If you wish to change from
one to the other we will have to be notified to make the necessary
changes.
The electronic option will not suit everybody yet. Those who
wish to take up the online option will be sent access details and
user instructions, Fellows interface quick
start guide (PDF 717 KB). When submitting information to the
audit office, ensure that the study ID and patient UR number are
clearly labelled on all the supporting documentation. Please
contact your local audit office for further details on submitting
surgical case forms online.
Reports and publications
Manual - Fellows
interface quick start guide (PDF 717 KB)
Form - Surgical case form
(PDF 417 KB)
Links
AOA Joint Replacement Registry
Australasian
Health & Research Data Managers Association
Australasian Society for Cardiac and Thoracic
Surgeons
The Australian
and New Zealand College of Anaesthetists (ANZCA)
Australian and
New Zealand Intensive Care Society (ANZICS)
Clinical Registries
Department of Health, ACT, Australia
The Haemostasis Registry
Health Issues Centre
National
E-Health Transition Authority
The Royal
Australasian College of Medical Administrators
Scottish Audit of
Surgical Mortality
National Coroners
Information System
Seminars
ACTASM seminar or workshop date and program will be posted on
here.
Contact
All general enquiries can be directed to:
ACTASM - Royal Australasian College of Surgeons
Telephone: +61 2 6285 4558
Email: actasm@surgeons.org
Clinical Director - Dr John Tharion
Project Manager - Karen Ramsden