Western Australian Audit of Surgical Mortality

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

 Background

Summary

WAASM commenced on 1 June 2001 as a pilot project, under the management of the University of Western Australia.

In 2005 management of the project was transferred to the College. The WAASM Management Committee oversees the project which constitutes an invaluable foundation to the running and success of the audit program.

The project is funded by the Western Australian Department of Health (WADH).

In November 2006, the WADH issued an operational directive stating that all deaths that occur in public hospitals and licensed private health care facilities providing services for public patients are required to be classified and reviewed under the Western Australian Review of Mortality (WARM). WARM came into effect on 1 January 2007. Deaths that are reviewed under the WAASM process are exempt from the WARM process.

Similar projects are now running in most states including Australian Capital Territory (ACTASM),  Northern Territory (NTASM),  Queensland (QASM), South Australia (SAAPM), Tasmania (TASM), and Victoria (VASM). 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:

1. it independent
2. it is external
3. it is peer-reviewed
4. it is systematic
5. it is routine
6. it is objective
7. it is confidential (all audits are covered by qualified privilege at a Commonwealth level).

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:

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

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

To start, WAASM is notified of all deaths that occur in Western Australia through The Open Patient Administration System (TOPAS). In the case of private and smaller regional hospitals that are not linked into the TOPAS system, WAASM is notified of all deaths directly by the medical records department.

Next, WAASM sends a Surgical Case Form to the consultant surgeon linked to the case. The Surgical Case Form is:

1. completed by the consultant surgeon or a registrar (under supervision)
2. returned to WAASM in the envelope provided (as soon as possible)
3. 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, insufficient information has been provided on the Surgical Case Form or the case needs further investigation) then these steps are followed:

1. a second-line assessor is chosen by WAASM staff based upon a set of criteria created to minimise any selection bias
2. medical records are requested
3. the second-line assessor then reviews the Surgical Case Form; the medical records; and the first-line assessor's comment (comments from first- line assessor are transcribed onto the second-line assessors form), 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
4. the report and relevant feedback is sent to the original surgeon. The case is then closed.
5. at each stage of the process the original surgeon has right of reply.

Frequently asked questions

Do I have to participate in the WAASM?
Your participation in WAASM 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 WAASM 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 sent with along with surgical proformas forms. An example of a second-line assessment report (1-2 page) is also sent to you.

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

How will WAASM know if a patient has died under my care?
WAASM is notified of all deaths either through TOPAS or medical records departments.

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

What do I do after completing the WAASM Surgical Case Form?
Please return the Surgical Case Form to WAASM in the envelope provided.
Send us an email if you have any questions or concerns.

Who do I contact if I have any queries?
Please contact the WAASM 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

Annual reports

WAASM Annual Report 2011 (PDF 3 MB)
WAASM Annual Report 2010 (PDF 6 MB)
WAASM Annual Report 2009 (PDF 10 MB)
WAASM Annual Report 2008 (PDF 516 KB)
WAASM Annual Report 2007 (PDF 1 MB)
WAASM Annual Report 2006 (PDF 320 KB)
WAASM Annual Report 2004 (PDF 249 KB)

Case Note Review

Read the documents (members only)

Form

Surgical Case form (PDF 68 KB)

Manual

ASM Fellows interface quick start guide (PDF 717 KB)

Newsletter

Read the WAASM newsletter (members only)

Consumer booklet

WAASM consumer booklet (PDF 332 KB)

Presentation

Recognising the Deteriorating Patient (WAASM Symposium February 2011) - Watch or listen to this presentation online or download the video or the audio file (duration: 2 hours) from The University of Western Australia website

Please note that content regarding the Care of the Critically Ill Surgical Patient (CCrISP) Course contained in this presentation is the property of the Royal College of Surgeons of England (RCS) and is delivered throughout Australasia by the Royal Australasian College of Surgeons. Further information regarding this course can be found at the RCS website and the CCrISP section of this website.

Links

School of Population Health (CHSR)Department of Health, Western AustraliaClinical Training and Education Centre (CTEC) 
Scottish Audit of Surgical Mortality (SASM) 
National Confidential Enquiry into Patient Outcome and Death (NCEPOD)

Seminars

WAASM seminar or workshop date and program will be posted on here.

Contact

All general enquiries can be directed to:
WA Audit of Surgical Mortality (WAASM) 
University of Western Australia
M308, 35 Stirling Highway
Crawley WA 6009 Australia

Telephone: +61 8 6389 8650
Fax: +61 8 6389 8655
Email: waasm@surgeons.org

Clinical Director - Mr James Aitken
Project Manager - Dr Diana Azzam
Project Officer - Adeline Neo
Project Officer - Franca Itotoh