Northern Territory Audit of Surgical Mortality

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The Find a Surgeon directory is a listing of active Fellows of the Royal Australasian College of Surgeons who meet the requirements of the College's Continuing Professional Development (CPD) Program and have opted to be on the list. This list excludes retired or inactive Fellows.

Last Update: 21/05/2012 13:49

Background
Qualified privilege
Audit process
Frequently asked questions
Electronic platform - Fellows interface
Lessons from the audit
Reports and publications
Seminars
Contact

Background

A clinical audit is particularly relevant to the surgical specialties. It is accepted as an essential component of the evidence-based process of performance appraisal. Surgical audit is a regular, documented, critical analysis of the outcomes of surgical care. The results are reviewed by peers and used to further inform surgical practice.

The Northern Territory Audit of Surgical Mortality (NTASM) is an important initiative of the Royal Australasian College of Surgeons and its Fellowship to peer review the clinical management of deaths occurring during surgical admission in the Northern Territory. Funding for this project is provided by the Northern Territory Department of Health and Families.

The principal aim of NTASM is to improve the quality of healthcare through feedback and education. In order to achieve this, evidence from local audit data is required.

Feedback in individual and group formats is produced. Individual feedback is thus provided to individual surgeons and aggregate data is disseminated to all surgeons and hospitals.

Surgeons are protected by statutory immunity through Commonwealth Qualified Privilege legislation. This legislation is designed to strongly encourage clinical professionals to engage in quality and safety initiatives in order to bring about improvements in care.

Summary

The Northern Territory Audit of Surgical Mortality (NTASM) began in June 2010. It is funded by Northern Territory Department of Health and Families. Two Northern Territory public hospitals are currently participating:

Royal Darwin Hospital
Alice Springs Hospital

The Northern Territory Department of Health and Families provides members to a NTASM Management Committee. The committee reviews de-identified, quantitative reports so it can further improve and reform health provision in Northern Territory. It follows methodology established and refined by similar projects that are concurrently running in Australian Capital Territory (ACTASM), Queensland (QASM), South Australia (SAAPM), Tasmania (TASM), Victoria (VASM) and Western Australia (WAASM). NTASM is administered from the QASM office. 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:

it is independent
it is external
it is peer-review
it is systematic
it is routine
it is objective
it is confidential (all audits are covered by qualified privilege at a commonwealth level).

Conclusion

Fellows of the College have always had accountability through personal audits and professional excellence. These qualities have been included in the College's Continuing Professional Development (CPD) Program.

However, it is acknowledged that while a high level of qualitative accountability exists at an individual level, there is a need from health service providers for quantitative accountability.

This quantitative accountability and also the qualitative measures are integral to the needs of those health service providers. It is also integral to reporting information to the general public. It is anticipated that statewide reporting and quality of care can be enhanced through NTASM.

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 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. 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

NTASM is a peer-review process. Participation by consultant surgeons is a requirement of the College's Continuing Professional Development (CPD) Program.

To start: NTASM is notified by the hospital of all surgically-related deaths (before, during or after surgery)

Next: NTASM sends a Surgical Case Form (PDF 346 KB) to the consultant surgeon linked to the case. This may be sent by post or by email if the surgeon is using the Fellows interface.

The Surgical Case Form is:

completed by the consultant surgeon or a registrar (under supervision)
returned to NTASM in the reply paid envelope (as soon as possible) or electronically using the Fellows interface
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, the case needs further investigation or insufficient information has been provided on the Surgical Case Form) then these steps are followed:

a second-line assessor is chosen by NTASM's Clinical Director
medical records are requested
the second-line assessor then reviews the Surgical Case Form, the medical records and the first-line assessor's comment, before writing a one or two-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
the report and relevant feedback is sent to the original surgeon. The case is then closed
at each stage of the process the original surgeon has right of reply.

Frequently asked questions

Do I have to participate in NTASM?
Participation in an audit of surgical mortality is a requirement of the College's CPD Program under Category One: Surgical Audit and Peer Review.

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 NTASM without being a first-line assessor, and/or a second-line assessor.

Are any instructions/guidelines provided for first and/or second-line assessors?
Guidelines are printed on the first-line and second-line assessment forms sent to you. An example of a second-line assessment report (1-2 page) is also sent to you.

Is the NTASM process confidential?
All data and forms are de-identified. All data and forms are securely stored. NTASM reports are covered by qualified privilege.

How will NTASM know if a patient has died under my care?
NTASM is notified (regularly) of surgically related deaths that occur in 4 Northern Territory public hospitals. Notification occurs through the hospitals' medical records departments or the mortality and morbidity meetings of the hospital.

What if I need the medical records to fill out the NTASM Surgical Case Form?
Contact the medical records department of your hospital to ensure records can be located and delivered to you.

What do I do after completing the NTASM Surgical Case Form?
Please return the Surgical Case Form to QASM in the reply paid envelope provided or electronically using the Fellows interface. Contact us if you have any questions or concerns.

Who do I contact if I have any queries?
Please contact the NTASM Project Manager.

Electronic platform - Fellows interface

ANZASM now offers an electronic submissions platform called Fellows interface. If you do not have a username and password email the NTASM office. The paper-based submission format is still current and available. When submitting information to the audit office, ensure that the study ID and patient UR number are clearly labelled on all the supporting documentation.

Lessons from the audit

Read the issues of Lessons from the audit (members only)

Reports and publications

Annual reports

Annual Report 2010-2011 (PDF 1.07 MB)

Publications

Teleconference fracture clinics: a trial for rural hospitals by J North (PDF 934 KB)

Seminars

3 August 2012, in conjunction with QASM, NTASM will be co-hosting a seminar for registered nurses, midwives and paramedics. The theme is "Distance, Delays, Deteriorating Patients." Download the flyer (PDF 171 KB) and the program (PDF 111 KB) which gives details of venue, times, registration. To register please email qasmseminar@surgeons.org or phone 07 3835 8671.

Contact

All general enquiries can be directed to:
NTASM - Royal Australasian College of Surgeons
PO Box 79
Spring Hill QLD 4004 Australia

Email: ntasm@surgeons.org
Telephone: +61 7 3835 8671
Fax: +61 7 3236 9320

Clinical Director - Dr John North
Project Manager - Therese Rey-Conde
Project Officer - Jenny Allen
Administrative Officer - Kyrsty Webb
Darwin Contact - Gayle Eccles

Royal Australasian College of Surgeons