Frequently asked questions
Electronic platform - Fellows interface
Reports and publications
Submission for Data Request
Case Note Review
Committee Meeting Dates
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 Surgical Mortality (SAASM) 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 SAASM 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 SAASM 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
The Qualified Privilege (QP) declaration (PDF
2.1MB) encourages surgeon participation within the mortality audits
by strictly protecting the confidentiality of information gained in
Via a blend of state and commonwealth legislation, the
declaration prevents third parties from using data that becomes
available as a result of the prescribed activity cannot be
disclosed (in reports or publications) outside of the activity in a
manner that identifies a surgeon. The confidentiality of the
information received is protected accordingly and high-level data
security procedures are maintained.
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.
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
QP declarations encourage participation of surgeons by
protecting the confidentiality of information created as part of
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
The regional surgical mortality audits are permitted
- 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
- 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
Participating surgeons in the audit are permitted to identify
other practitioners involved in the case.
ANZASM in partnership with Russell Kennedy lawyers compiled the
QP guide (PDF 2.1MB). For further information
about the QP scheme contact
SAASM is a peer-review process. Participation
by consultant surgeons is a requirement of the College's Continuing Professional
Development (CPD) Program.
To start: SAASM is notified by the hospital of
all deaths that occurred during a surgical admission (before,
during or after surgery).
Next: SAASM sends an email notification to the
treating surgeon with a link to complete the surgical case form.
Surgical case forms are completed online using the Fellows Interface.
The Surgical Case Form is:
- completed and submitted by the consultant surgeon or a
registrar/trainee (under supervision)
- de-identified and sent to a first-line assessor (a consultant
surgeon; same speciality, different hospital) for anonymous
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 SAASM 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
Expansion of the surgical mortality audits includes the
collaboration between the SAASM and the South Australian
Anaesthetic Mortality Committee (SAAMC).
From information provided by treating surgeons as part of the
surgical mortality audit process, the SAASM identifies a potential
anaesthetic component to the death of the patient from Q17 ('Was
there an anaesthetic component to the patient death?'). If the
answer to the question is 'Yes' then the SAASM refers the cases on
a monthly basis to the SAAMC for a further anaesthetic assessment.
This process is fully covered by the ANZASM Qualified Privilege
(gazetted 25th July 2016).
The SAAMC's role is to analyse adverse event information,
specifically patient mortality, from health services related to
anaesthesia with the objective of recommending quality improvement
initiatives. In addition, an assessment report can be provided to
the responsible anaesthetist (if requested). The SAASM is provided
with a copy of the final anaesthetic assessment to enable
monitoring and reporting of assessment outcomes (without disclosing
any of the information contained in individual assessments).
Developments in the surgical mortality audits comprise the
inclusion of our Gynaecological colleagues into SAASM. The audit is
notified of all deaths occurring after a gynaecological surgical
procedure. Participation by Royal Australian and New Zealand
College of Obstetrics and Gynaecology (RANZCOG) Fellows is
currently considered voluntary under RANZCOG CPD requirements.
Frequently asked questions
Do I have to participate in SAASM?
Your participation in SAASM 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
You can choose to be a first-line assessor, and/or a
You can participate in SAASM 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 SAASM process confidential?
All data and forms are de-identified. All data and forms
are securely stored.
SAASM reports are covered by Commonwealth Qualified Privilege.
How will SAASM know if a patient has died under my
SAASM 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 SAASM
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 SAASM office.
What do I do after completing the SAASM Surgical Case Form?
Please return the Surgical Case Form to SAASM in the
reply paid envelope provided.
Please contact the SAASM office if you have
any questions or concerns.
platform - Fellows interface
ANZASM now utilises an electronic submissions platform called Fellows Interface. The new
interface allows Fellows to self-report, complete and transmit
surgical case and first-line assessment forms securely online.
User guides are provided below:
Fellows Interface User Guide (PDF 3.1MB)
Self-generated Notification of Death User
Guide (PDF 258KB)
Third Party Delegates User Guide (PDF
Third Party Delegation - Fellows User Guide
2015-2016 (PDF 1.9MB)
Executive Summary 2015-2016 (PDF 88KB)
SAAPM Annual Report 2015 (eBook)
SAAPM Annual Report 2015 (PDF 4.2MB)
SAAPM Annual Report 2014 (PDF 2.21MB)
and SAAPM Annual Report Overview 2014 (PDF
SAAPM Annual Report 2013
SAAPM Annual Report 2012 (PDF 4.8MB)
SAAPM Annual Report 2011 (PDF 2MB)
Report 2010 (PDF 1.9MB)
Report 2009 (PDF 1.4MB)
Report 2008 (PDF 8.4MB)
Report 2007 (PDF 4.7MB)
SAAPM Annual Report 2006 (PDF
Case note review
SAAPM 2010 - Volume 3 (PDF 1.1MB)
Go to ANZASM for the National Case Note Review Booklets
July 2017 (eNews)
Oct 2016 (eNews)
Jun 2016 (eNews)
Mar 2016 (eNews)
Aug 2015 (PDF 448KB)
May 2015 (eNews)
May 2015 (PDF
Feb 2015 (PDF 171KB)
Nov 2014 (PDF 301KB)
Aug 2014 (PDF 274KB)
Second-Line Assessment Form (PDF 107KB)
Data Request Form (PDF 1.1MB)
Interface User Guide (PDF 3.1MB)
Potentially avoidable issues in neurosurgical
mortality cases in Australia ANZ Journal of Surgery, Apr
The Australia and New Zealand Audits of Surgical Mortality
(ANZASM) will consider requests for data and data extracts for
special reports. ANZASM is a declared Quality Assurance Activity
and is required to work within specific requirements of the
declaration. ANZASM must protect the confidentiality of the
information it receives, to respect the privacy and sensitivity of
those to whom it relates and maintain high-level data security
procedures. Only de-identified data can be released.
- Requests for data should accompanied by a reason why the
analyses are required.
- Requests should have a clear & realistic plan.
- Requests require approval by the audit data-request
subcommittee and final endorsement by the ANZASM Steering
- Once approved, requests will be prioritised and work will
proceed according to the priority list.
- It is expected that abstracts be progressed into manuscripts
within one year.
- All publications prepared from this RACS data need to be
approved by the Director of RAAS, Chair RAAS and Chair
ANZASM. All publications from RAAS are reported to the RACS
Please email the completed data request form (PDF 1.1MB) to the RAAS
Director, Wendy.Babidge@surgeons.org for
national data extraction. Alternatively contact the regional audit of mortality manager
for regional data extracts.
FREE Upcoming SAASM Seminar, Thursday 12 April
2018, 6:00pm - 8:30pm, "Nobody Told Me: Poor
Communication Kills - A case series and panel discussion
highlighting the importance of effective communication", Education
Development Centre, 4 Milner St, Hindmarsh SA 5007. Download program (PDF 546 KB). Register here.
SAASM Seminar on 25
October 2016, "End of life matters". Download the program (PDF 714KB).
Presentations for this seminar can be downloaded below:
Glen McCulloch, Introduction and opening remarks (PDF
Prof Ian Olver, Ethics of non-treatment (PDF 196KB)
A/Prof Sarah Thompson, General Surgery (PDF 2.4MB)
Mr Michael Berce, Vascular Surgery (PDF 266KB)
Dr Greg Rice, Cardiothoracic Surgery (PDF 2.3MB)
Mr Stephen Santoreneos, Neurosurgery (PDF 606KB)
Dr Christopher Beare, Perioperative Physician's perspective (PDF
A/Prof Mary White, Intensive Care perspective (PDF 2.1MB)
Dr Chris Moy, End of life care basics (PDF 4.7MB)
Dr Christine Drummond, Tales of a porcupine (PDF 398KB)
Prof Ian Olver, Communication (PDF 168KB)
NT, SA, and WA Annual
Scientific Meeting, 7-8
August 2015, "Extended scope of practice for surgeons and health
care practitioners generalism in surgery: Its role with the
specialists". Hilton Hotel, Darwin. For more
information email the SAAPM office.
SAASM Seminar on 23 July 2015, "The
decision to operate - or not". Download the program (PDF 671KB). Presentations for this
seminar can be downloaded below:
Mr Glenn McCulloch Introduction and 10 years of SAAPM (PDF
Dr Ivan Ward Pre-operative assessment, watch video (PDF
Dr Greg Rice Risk prediction in Cardiac Surgery, watch
Mr David Hill P-POSSUM exposed, watch video (PDF
Prof Robert Fitridge Predicting outcomes in Vascular Surgery - when not
to operate, watch video (PDF 1.7MB)
Dr Katy Gibb Saying 'No'- a physician's
perspective, watch video (PDF 258KB)
Dr Jennie Louise Futility and the ethics of saying
'No', watch video (PDF 221KB)
Dr David Evans High risk procedures - an ICU
perspective, watch video (PDF 1.9MB)
SAASM Seminar on 28 February 2012,
"Recognising the deteriorating patient". Download the program (PDF 161 KB).
All general enquiries can be directed to:
SAASM - Royal Australasian College of Surgeons
199 Ward Street
North Adelaide SA 5006
Telephone: +61 8 8219 0914
Fax: +61 8 8239 1244
Clinical Director - Mr Glenn McCulloch
Project Manager - Sasha Stewart
Senior Project Officer - Kimberley Penglis
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