Last Update: 10/04/2012 17:04
Background
Qualified privilege
Audit process
Frequently asked questions
Electronic platform - Fellows interface
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 South Australian Audit of Peri-operative Mortality (SAAPM)
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 South Australia.
Funding for this project is provided by SA Health. The SAAPM
Management Committee meets twice a year and has oversight of
the project which constitutes an invaluable foundation to the
running and success of the audit program.
The principal aim of SAAPM 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.
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
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 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)
- 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 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
SAAPM is a peer-review process. Participation
by consultant surgeons is a requirement of the College's Continuing Professional
Development (CPD) Program.
To start: SAAPM is notified by the hospital of
all deaths that occurred during a surgical admission (before,
during or after surgery).
Next: SAAPM sends a Surgical Case form to the treating
surgeon linked to the case.
The Surgical Case Form is:
- completed by the consultant surgeon or a registrar (under
supervision)
- returned to SAAPM in the reply paid envelope (as soon as
possible)
- 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 at this point (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 selected
- medical records are requested by SAAPM project staff
- the second-line assessor then reviews the Surgical Case Form;
the medical records; and the first-line assessor's comment, 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
- 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 SAAPM?
Your participation in SAAPM 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 SAAPM 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 provided. They 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 SAAPM process confidential?
All data and forms are de-identified. All data and forms
are securely stored.
SAAPM reports are covered by Commonwealth Qualified Privilege.
How will SAAPM know if a patient has died under my
care?
SAAPM is notified (regularly) of deaths that occur by the
medical records departments of participating hospitals and by a
centralised state-wide data source through SA Health.
What if I need the medical records to fill out the SAAPM
Surgical Case Form?
Contact the medical records department of your hospital to
ensure records can be located & delivered to you. If you
require assistance with this, please contact
the SAAPM office.
What do I do after completing the SAAPM Surgical Case Form?
Please return the Surgical Case Form to SAAPM in the reply
paid envelope provided.
Please contact the SAAPM office if you have
any questions or concerns.
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 do
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
Annual reports
SAAPM Annual
Report 2010 (PDF 1.9 MB)
SAAPM Annual
Report 2009 (PDF 1.4 MB)
SAAPM Annual
Report 2008 (PDF 8.4 MB)
SAAPM Annual
Report 2007 (PDF 4.7 MB)
SAAPM Annual Report 2006 (PDF
192 KB)
Case note review
Read the documents (members only)
Manual
Fellows
interface quick start guide (PDF 717 KB)
Form
Surgical Case form
(PDF 347 KB)
Seminars
SAAPM Seminar (28 February 2012, Hindmarsh)
The South Australian Audit of Perioperative Mortality in
collaboration with SA Health, invites surgeons and surgical
trainees to a free seminar on "Recognising the deteriorating
patient" on the 28 February 2012.
Download the flyer (PDF 161 KB) which gives
details of venue, times, registration and our program of excellent
speakers and their topics.
Contact
All general enquiries can be directed to:
SAAPM - Royal Australasian College of Surgeons
PO Box 3115
Melbourne Street
North Adelaide SA 5006
Telephone: +61 8 8239 1144
Fax: +61 8 8239 1244
Email: saapm@surgeons.org
Clinical Director - Mr Glenn McCulloch
Project Manager - Kenneth Lang
Project Officer - Heather Martin