Victorian Audit of Surgical Mortality

Background
Qualified privilege
Audit process
Frequently asked questions
Electronic platform - Fellows interface
Reports and publications
Seminars
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 Health, the Victorian Surgical Consultative Council and the Royal Australasian College of Surgeons. The VASM project is funded by the Victorian Department of Health. The VASM Management Committee meets bimonthly and oversees the project which constitutes an invaluable foundation to the running and success of the audit program. 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

A 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.

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:

1. how the national QP legislation imposes responsibilities for legal disclosure of audit-related information on both the regional audits and their related audit staff
2. what information the regional audit is permitted to disclose to hospitals (in relation to the Commonwealth QP scheme)
3. 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:

1. provide annual state and hospital reports that contain aggregated, de-identified (with respect to surgeon and patient) data that will report on the following:
2. audit participation rates for their surgeons (exception: hospitals with consultant numbers less than two).
3. hospital specific rates of optimal or suboptimal care of patients as compared to state and national averages.
4. 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:

1. 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,
2. 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:

1. chief executive officers, or
2. 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:

1. identifying information can only be disclosed with the express approval of the identified individuals.
2. 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

VASM is a peer-review process. Participation by consultant surgeons is a requirement of the College's Continuing Professional Development (CPD) Program. The audit process is initiated by notification of the death of a patient while under surgical care. The following procedure is followed:

1. 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
2. Completed case record forms are returned to the VASM office
3. All identifying information is removed from the form
4. 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
5. 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
6. If no further review is felt necessary, the treating surgeon will receive feedback to this effect and the case will be closed
7. 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)
8. 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
9. When complete, the outcome of this review will then be fed back to the (treating) surgeon responsible for patient care

Frequently asked questions

Do I have to participate in VASM?
Your participation in VASM 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 choose to participate in VASM, 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.

Are any instructions/guidelines provided to those who volunteer to be 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 VASM process confidential?
Yes. All data is de-identified and is securely stored at the VASM office.

How will VASM know if a patient has died under my care?
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.

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?
Yes. The medical records department of each hospital will locate medical records for you.

What do I do once I have completed the VASM case record form?
Once you have completed the case record form, please return it to VASM's dedicated PO Box in the reply paid envelope provided.

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

Annual reports

VASM Annual Report Summary 2010 (PDF 2 MB)
VASM Annual Report 2010  (PDF 104 MB)
VASM Annual Report 2009 (PDF 1.8 MB)
VASM Hospital Report 2008 (PDF 2.6 MB)
VASM Annual Report 2008 (PDF 1.9 MB)

Case note review

Read the documents (members only)

External evaluation  

ASPEX Evaluation Report on VASM (PDF 1.3 MB)

Manual

Fellows interface quick start guide (PDF 717 KB)

Newsletter

Read the editions of the VASM newsletter (members only)

Validation audit

Read the documents (members only)

Audit guidelines

VASM Audit Process Timeline (PDF 28 KB)
A Guide for Victorian Hospitals (PDF 1 MB)
Guideline for first and second line assessors (PDF 1 MB)

VASM forms

Notification of Death (NOD) Form (PDF 1.2 MB)
Case Record Form (CRF) (PDF 255 KB)
First Line Assessment (FLA) Form (PDF 298 KB)
Second Line Assessment (SLA) Form (PDF 29.9 KB)

Abstract

View the documents (members only)

Poster

View the posters (members only)

Presentation

View the presentations (members only)

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)
Bosentan Patient Registry
Clinical Registries
Department of Health, Victoria, Australia
The Haemostasis Registry
Health Issues Centre
Melbourne Vascular Surgical Association
MIG Registry
National E-Health Transition Authority
The Royal Australasian College of Medical Administrators
Scottish Audit of Surgical Mortality
State Coroners Office of Victoria
Victorian Admitted Episodes Data Set (VAED)
Victorian State Trauma Registry
Victorian Surgical Consultative Council (VSCC)

Seminars

VASM Seminar (23 February 2012, Melbourne)

The Victorian Audit of Surgical Mortality, Victorian Surgical Consultative Council, Victorian Department of Health  and Victorian Managed Insured Agency are pleased to invite you and your staff to attend the Seminar on Managing the Deteriorating Patient  on the 23 February 2012 in Melbourne. The seminar will commence at 1.00 PM and finish at 5.00.

Managing the deteriorating patient has been identified in the VASM audit process as a common issue preceding death. Clinical scenarios and a panel discussion are included in the program. We look forward to your participation in this opportunity to lift our performance in providing the best and safest clinical care.

Download the flyer (PDF 50 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:
VASM - Royal Australasian College of Surgeons
GPO Box 2821
Melbourne VIC 8060 Australia

Telephone: +61 3 9249 1128
Fax: +61 3 9249 1130
Email: vasm@surgeons.org

Clinical Director - Associate Professor Colin Russell
Project Manager - Claudia Retegan
Senior Project Officer - Jessele Vinluan
Project Officer - Karen Crowley
Project Officer - Mary Jane Sterry
Administrative Research Officer - Rajneet Arora
Administrative Research Officer - Andrew Chen