Queensland 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

Australia is one of the few places in the world to attempt a nationwide audit of surgical deaths and this shows that surgeons regard patient safety as paramount. What the latest international research tells us is that when there is an adverse event, it is rarely as a result of one person. It is usually a team failure.

"This is not about finding scapegoats or blaming or shaming, it is about how we can improve surgical performance to get better results." Former President, Royal Australasian College of Surgeons, Dr Andrew Sutherland.

Summary

Queensland Audit of Surgical Mortality (QASM) started in 2007. QASM is funded by Queensland Health. The 23 Queensland public hospitals currently participating are:

Bundaberg Hospital
Caboolture Hospital
Cairns Base Hospital
Caloundra Hospital
Gold Coast Hospital
Gympie Hospital
Hervey Bay Hospital
Ipswich Hospital
Logan Hospital
Mackay Hospital
Mater Adult Hospital
Mater Children's Hospital
Mt Isa Hospital
Nambour Hospital
Princess Alexandra Hospital
Queen Elizabeth II Jubilee Hospital
Redcliffe Hospital
Rockhampton Base Hospital
Royal Brisbane & Women's Hospital
Royal Children's Hospital
The Prince Charles Hospital
The Townsville Hospital
Toowoomba Hospital

Queensland Health provides members to a QASM Management Committee. The committee reviews de-identified, quantitative reports, so it can further improve and reform health provision in Queensland.

QASM - Royal Australasian College of Surgeons is gazetted as an "approved quality assurance committee" in accordance with section 31 of the Health Services Act 1991.

QASM follows methodology established and refined by similar projects that are concurrently running in the Australian Capital Territory (ACTASM), Northern Territory (NTASM), South Australia (SAAPM), Tasmania (TASM), Victoria (VASM) and Western Australia (WAASM). 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 (Queensland Health is a significant provider) 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 QASM.

Qualified privilege

Overview

The Qualified Privilege (QP) declaration has been designed to encourage surgeon participation within the mortality audits by strictly protecting the confidentiality of information gained in the audit.

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

It 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 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 Audits 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.

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 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

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

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

Next: QASM sends a Surgical Case form (PDF 347 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 QASM 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 (PDF 347 KB) then these steps are followed:

a second-line assessor is chosen by QASM's Clinical Director
medical records are requested
the second-line assessor then reviews the Surgical Case form (PDF 347 KB) 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 the QASM?
Your participation in QASM 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 QASM 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 printed on the first-line and second-line assessment forms sent to you. An example of a second-line assessment report (1 to 2 pages) is also sent to you.

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

How will QASM know if a patient has died under my care?
QASM is notified (regularly) of surgically-related deaths that occur in 19 Queensland public hospitals. Notification occurs through the hospitals' medical records departments.

What if I need the medical records to fill out the QASM 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 QASM 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 QASM 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 QASM 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 and 2011 (PDF 1.24 MB)
Annual Report 2009 (PDF 12 MB)
Annual Report 2008 (PDF 10 MB)

Publications

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

Form

Surgical Case form (PDF 347 KB)
Consultant Participaton Form (PDF 387 KB)

Manuals

Fellows interface quick start guide (PDF 717 KB)

Newsletters

View the editions of the QASM newsletter (members only)

Qualified Privilege

Read about qualified privilege (members only)

General links

Science Direct - access to Journal of Vascular Surgery
American Medical Association (AMA) - access to other journals
Wiley
Highwire Press
Sage Publications

Seminars

Previous event:
November 2011, QASM Worskhop report.

Future events:
3 August 2012, QASM will be 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.

10 November 2012, QASM will be hosting its annual seminar for surgeons. This will take place at 53 Albert Street (17th floor), Brisbane city. All surgeons are welcome.

Contact

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

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

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

Royal Australasian College of Surgeons