
Background
Qualified privilege
Audit process
ANZCA process
Frequently asked
questions
Electronic platform - Fellows
interface
Reports and publications
Submission for Data Request
Forms
Seminars
Committee Meeting Dates
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 Tasmanian Audit of Surgical Mortality (TASM) is an external,
independent peer process that reviews the clinical management
surrounding deaths that occurred during surgical admission when
patients are admitted under consultant surgeons as well as
in-hospital deaths where an anaesthetically related component to
the death may be a possibility.
TASM is a joint initiative between the Royal Australasian
College of Surgeons that provides office resources for this project
and the Tasmanian Department of Health and Human Resources fund all
other resources required. The TASM Management Committee
oversees the project which constitutes an invaluable
foundation to the running and success of the audit program.
The principal aim of TASM is to improve the quality of
healthcare through feedback and education. In order to achieve
this, evidence from local audit data is required. TASM commenced
data collection in September 2004.
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 (PDF
2.1MB) has been designed to encourage 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 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.
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 Qualified Privilege (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 (PDF 2.1MB). For further information
about the QP scheme contact
ANZASM.
Audit
process
TASM is a peer-review process. Participation by consultant
surgeons is a requirement of the College's Continuing Professional
Development (CPD) Program.
To start: TASM is notified by the hospital of
all deaths that occurred during a surgical admission or where there
is deemed to be the possibility of an anaesthetic related component
to the death.
Next: TASM sends a Surgical Case form
(PDF 254KB) to the treating surgeon or anaesthetist linked to the
case.
A Surgical Case Form or Anaesthetic data collection form is:
- completed by the consultant surgeon, anaesthetist or their
registrar (under supervision)
- returned to TASM in the reply paid envelope (as soon as
possible)
- de-identified and sent to a first-line assessor (a consultant
surgeon or anaesthetist; 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 or anaesthetist
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:
- an appropriate second-line assessor is selected
- medical records are requested by TASM project staff
- the second-line assessor then reviews the Surgical Case Form or
Anaesthetic data form, the patient's 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 or anaesthetist. The case is then closed.
- at each stage of the process the original surgeon has right of
reply.
ANZCA process
The TASM and the Australian and New Zealand College of
Anaesthetists (ANZCA) now collaborate in the collection of
anaesthetic-related surgical mortality.
TASM is notified by the hospital of all deaths that occurred
during a surgical admission, see flowchart (PDF 54KB).
There are two situations when an anaesthetist may be involved.
Firstly, when the treating surgeon alerts the possibility of an
anaesthetic component of the death or, secondly, when the death
occurs within 48hrs of the anaesthetic's being administered.
In either case, TASM will send an Anaesthetic Case Form (PDF 98KB) to the treating anaesthetist
for completion.
An Anaesthetic case form is:
- completed
by the consultant anaesthetist or registrar (under
supervision);
- returned
to TASM in the reply paid envelope (as soon as
possible);
- de-identified
and sent to a first-line assessor (a consultant anaesthetist; same
specialty, different hospital) for anonymous peer
review.
If a second-line assessment (case note review) is not requested
by the first-line assessor, the original anaesthetist 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
case form then these steps are followed:
- An
appropriate second-line assessor is selected.
- Medical
records are requested by TASM project staff.
- The
second-line assessor reviews the Anaesthetic Case Form (PDF
98KB), the patient's 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.
- The
report and relevant feedback is sent to the reporting anaesthetist.
The case is then closed.
- At each
stage of the process the reporting anaesthetist has right of
reply.
Frequently asked questions
Do I have to participate in TASM?
Your participation in TASM 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 TASM without being a first-line assessor,
and/or a second-line assessor.
Is the TASM process confidential?
All data and forms are de-identified. All data and forms are
securely stored.
TASM reports are covered by Commonwealth Qualified Privilege.
How will TASM know if a patient has died under my
care?
TASM is notified (regularly) of deaths that occur by the medical
records departments of participating hospitals.
What if I need the medical records to fill out the TASM
Surgical Case Form or Anaesthetic Data 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 us.
What do I do after completing the TASM Surgical Case
Form or Anaesthetic Data Form?
Please return the Surgical Case Form to TASM in the reply paid
envelope provided.
Contact us 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 self-report,
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.
Those who wish to take up the online option will be sent access
details, and user instructions see list of user guides below:
Fellows Interface User Guide (PDF 2.1MB)
Self-generated Notification of Death User
Guide (PDF 258KB)
Third Party Delegates User Guide (PDF
190KB)
Third Party Delegation - Fellows User Guide
(PDF 554KB)
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.
Reports and publications
Annual reports
TASM Annual Report 2016 (PDF 1.7MB)
TASM Annual Report 2015 (PDF
1MB)
TASM Annual Report 2014 (PDF 1.5MB)
TASM Annual Report 2013 (PDF 1.5MB)
TASM Annual Report 2012 (PDF 1.4MB)
TASM Annual Report 2011 (PDF 1.2MB)
TASM Annual Report
2010 (PDF 699KB)
TASM Annual Report
2009 (PDF 3MB)
TASM Annual Report
2008 (PDF 4.7MB)
TASM Annual Report
2007 (PDF 262KB)
TASM Annual Report
2006 (PDF 306KB)
Forms
Surgical Case form (PDF 254KB)
First-line Assessment Form (PDF 110KB)
Second-line Assessment Form (PDF 110KB)
Anaesthetic Case Record Form (PDF 98KB)
Data Request Form (PDF 1.1MB)
Case note review
TASM
and WAASM - November 2017 (PDF 614KB)
TASM and
WAASM - December 2016 (PDF 1.5MB)
TASM and WAASM - July 2016 (PDF
626KB)
TASM and WAASM - October 2015 (PDF
177KB)
TASM and WAASM - December 2014 (PDF
304KB)
TASM and WAASM - September 2013 (PDF
189KB)
TASM and WAASM - September 2012 (PDF
300KB)
TASM and WAASM - September 2011 (PDF
92KB)
TASM and WAASM - January 2011 (PDF
79KB)
TASM and WAASM - December 2009 (PDF
102KB)
TASM and WAASM - August 2009 (PDF
65KB)
TASM and WAASM - April 2008 (PDF
161KB)
TASM and WAASM - April 2007 (PDF
184KB)
TASM and WAASM - August 2006 (PDF 161KB)
Submission for
Data Request
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
Committee.
- 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 Council.
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.
Seminars
Future events
VASM-TASM Seminar on 12 July 2018
on "Unexpected death - What now?". This seminar will be held
between 4pm - 6pm in the Lecture Theatre, Launceston General
Hospital, Launceston, TAS 7250. Download program (PDF
212KB).
Previous events
TASM Seminar on 3 November
2017, "How can registries and audits improve patient outcomes - a
Tasmanian perspective?" 12.30pm to 2.00pm, Keith Milligen Lecture
Theatre, Royal Hobart Hospital. Download report (PDF 50KB).
TASM Workshop on 11 August 2016,
"Would you have changed the management of this patient's course to
death?" 03.00pm to 5.00pm, Launceston General Hospital,
Tasmania. Download report (PDF
35KB).
Presentations for
this seminar can be downloaded
below:
Dr Amanda Young, General Surgery: Too many cooks (PDF
130KB).
Mr Nigel
Broughton, Orthopaedic Surgery: Can we do better? (PDF
661KB).
Mr
Stephen Brough, Urological Surgery: Can we change the outcome?
(PDF
79KB).
TASM Workshop on 16 October 2015, "Would
you have changed the management of this patient's course to
death?". Download program (PDF 1.3MB) and download report (PDF 56KB).
Contact
All general enquiries can be directed:
TASM - Royal Australasian College of Surgeons
147 Davey Street
Hobart TAS 7000 Australia
Telephone: +61 3 6223 8848
Fax: +61 3 6223 5019
Email: tasm@surgeons.org
Project Manager - Ms Lisa Lynch
back to the top