Queensland Audit of Surgical Mortality

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Find a surgeon

The Find a Surgeon directory is a listing of active Fellows of the Royal Australasian College of Surgeons who meet the requirements of the College's Continuing Professional Development (CPD) Program and have opted to be on the list. This list excludes retired or inactive Fellows.

 

Background
Qualified privilege
Audit process
Frequently asked questions
Electronic platform - Fellows interface
Lessons from the audit
Reports and publications
Submission for Data Request
Forms
Newsletter
Seminars
Committee Meeting Dates
Contact

Background

Australia is one of the few places in the world to attempt a nationwide audit of surgical deaths and this shows that surgeons regard patient safety as paramount. What the latest international research tells us is that when there is an adverse event, it is rarely as a result of one person. It is usually a team failure.

"This is not about finding scapegoats or blaming or shaming, it is about how we can improve surgical performance to get better results." Former President, Royal Australasian College of Surgeons, Dr Andrew Sutherland.

Summary

Queensland Audit of Surgical Mortality (QASM) started in 2007. QASM is funded by Queensland Health. There are 38 public hospitals and 37 private hospitals currently participating in QASM.

Public hospitals currently participating are:


 1. Beaudesert Hospital 16. Mater Hospital Hospital
 2. Bundaberg Hospital 17. Mater Mothers' Hospital
 3. CabooltureHospital 18. Mt Isa Hospital
 4. CairnsHospital 19. Nambour General Hospital
 5. Caloundra Hospital 20. Princess Alexandra Hospital
 6. Gladstone Hospital 21. Queen Elizabeth II Jubilee Hospital
 7. Gold Coast University Hospital 22. Redcliffe Hospital
 8. Gympie Hospital 23. Redland Hospital
 9. Hervey Hospital 24. Robina Hospital
10. Ipswich Hospital 25. Rockhampton Hospital
11. Lady Cilento Children's Hospital 26. Royal Brisbane & Women's Hospital
12. Logan Hospital 27. The Prince Charles Hospital
13. Longreach Hospital 28. The Townsville Hospital
14. Mackay Hospital 29. Toowoomba Hospital
15. Maryborough Hospital

Private hospitals currently participating are:


 1. Brisbane Private Hospital 21. Mater Mothers' Private Hospital
 2. Caboolture Private Hospital 22. Mater Private Hospital Redland
 3. Cairns Day Surgery 23. Mater Private Hospital Springfield
 4. Friendly Society Private Hospital Bundaberg 24. Mater Women's and Children's Hospital Hyde Park
 5. Gold Coast Private Hospital 25. Nambour Selangor Private Hospital
 6. Gold Coast Surgical Hospital 26. Noosa Hospital
 7. Greenslopes Private Hospital 27. North West Brisbane Private Hospital
 8. Gympie Private Hospital 28. Peninsula Private Hospital
 9. Hervey Bay Surgical Hospital 29. Pindara Private Hospital
10. Hillcrest Rockhampton Private Hospital 30. South Burnett Private Hospital
11. Holy Spirit Northside Private Hospital 31. St Andrew's Ipswich Private Hospital
12. John Flynn Gold Coast Private Hospital 32. St Andrew's Toowoomba Hospital
13. Kawana Private Hospital 33. St Andrew's War Memorial Hospital
14. Mater Children's Private Hospital 34. St Stephen's Private Hospital (Hervey Bay)
15. Mater Hospital Pimlico 35. St Vincent's Private Hospital Toowoomba
16. Mater Private Hospital Brisbane 36. Sunnybank Private Hospital
17. Mater Misericordiae Hospital Bundaberg 37. Sunshine Coast University Private Hospital
18. Mater Misericordiae Hospital Gladstone 38. The Sunshine Coast Private Hospital
19. Mater Misericordiae Hospital Mackay 39. The Wesley Hospital
20. Mater Misericordiae Hospital Rockhampton

Queensland Health provides members to a QASM Management Committee. The committee reviews de-identified, quantitative reports, so it can further improve and reform health provision in Queensland.

QASM - Royal Australasian College of Surgeons is gazetted as an "approved quality assurance committee" in accordance with section 31 of the Health Services Act 1991.

QASM follows methodology established and refined by similar projects that are concurrently running in the Australian Capital Territory (ACTASM), Northern Territory (NTASM), South Australia (SAAPM), Tasmania (TASM), Victoria (VASM) and Western Australia (WAASM). 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 is independent
  2. it is external
  3. it is peer-review
  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).

Conclusion

Fellows of the College have always had accountability through personal audits and professional excellence. These qualities have been included in the College's Continuing Professional Development (CPD) Program. However, it is acknowledged that while a high level of qualitative accountability exists at an individual level, there is a need from health service providers (Queensland Health is a significant provider) for quantitative accountability.

This quantitative accountability and also the qualitative measures are integral to the needs of those health service providers. It is also integral to reporting information to the general public. It is anticipated that statewide reporting and quality of care can be enhanced through QASM.

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.

It prevents 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.

It 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 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 has received approval from the Minister of Health and Ageing to declare the Australian and New Zealand Audits of Surgical Mortality (ANZASM) a "quality assurance" activity under the Commonwealth QP scheme.

QP declarations are intended to 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. 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.

QASM is 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.

QASM is 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: Providing 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 (PDF 2.1MB). For further information about the QP scheme contact ANZASM.

Audit process

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

To start: QASM is notified by the hospital of all surgically-related deaths (before, during or after surgery).

Next: QASM sends a Surgical Case form (PDF 251KB) to the consultant surgeon linked to the case. This may be sent by post or by email if the surgeon is using the Fellows Interface.

The Surgical Case form is:

  1. completed by the consultant surgeon or a registrar (under supervision)
  2. returned to QASM in the reply paid envelope (as soon as possible) or electronically using the Fellows Interface
  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, the case needs further investigation or insufficient information has been provided on the Surgical Case form (PDF 251KB) then these steps are followed:

  1. a second-line assessor is chosen by QASM's Clinical Director
  2. medical records are requested
  3. the second-line assessor then reviews the Surgical Case form (PDF 251KB) the medical records and the first-line assessor's comment, before writing a one or two-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 QASM?
Your participation in QASM 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 QASM 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 printed on the first-line and second-line assessment forms sent to you. An example of a second-line assessment report (1 to 2 pages) is also sent to you.

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

How will QASM know if a patient has died under my care?
QASM is notified (regularly) of surgically-related deaths that occur in 19 Queensland public hospitals. Notification occurs through the hospitals' medical records departments.

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

What do I do after completing the QASM Surgical Case Form?
Please return the Surgical Case Form to QASM in the reply paid envelope provided or electronically using the Fellows Interface. Contact us if you have any questions or concerns.

Who do I contact if I have any queries?
Please contact the QASM Project Manager.

Electronic platform - Fellows interface

ANZASM now offers an electronic submissions platform called Fellows Interface. If you do not have a username and password email the QASM office.

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 3.1MB)
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.

Lessons from the audit

Lessons from the audit (members only)

Reports and publications

Annual reports

Annual Summary Report 2007-2015 (eBook)
Annual Summary Report 2007-2015 (PDF 365KB)
Annual Report 2007-2015 (eBook)
Annual Report 2007-2015 (PDF 1.9MB)
Annual Report 2007-2014 (eBook)
Annual Report 2007-2014 (PDF 3MB)
Annual Report 2012-2013 (PDF 1MB)
Annual Summary Report 2011-2012 (PDF 272KB)
Annual Report 2011 and 2012 (PDF 4.4MB)
Annual Report 2011 and 2012 (ebook)
Annual Report 2010 and 2011 (PDF 1.2MB)
Annual Report 2009 (PDF 12MB)
Annual Report 2008 (PDF 10MB)

Forms

Surgical Case form (PDF 251KB)
First-line Assessment form (PDF 106KB)
Second-line Assessment form (PDF 106KB)
Consultant Participaton Form (PDF 207KB)
Data Request Form (PDF 195KB)

Please return form to:
QASM - Royal Australasian College of Surgeons
PO Box 7476
East Brisbane QLD 4169 Australia

Manual

Fellows Interface User Guide (PDF 3.1MB)
Self-generated Notification of Death User Guide (PDF 1.1MB)

Newsletter

Quick Bits Issue 5 Aug 2016   (PDF 74KB)
Quick Bits Issue 4, Feb 2016   (PDF 81KB)
Quick Bits Issue 3, Jan 2015   (PDF 53KB)
Quick Bits Issue 2, Jul 2014   (PDF 218KB)
Quick Bits Issue 1, Jan 2014   (PDF 280KB)

Previous issues see  members only.

Publications

Challenges of Malignant Small Bowel Obstruction - Results of a State Surgical Mortality Dataset from British Journal of medicine & Medical Research, May 2016.
Clinical events reported by surgeons assessing their peers from American Journal of Surgery, May 2016
Surgical mortality audit data validity from Australia and New Zealand Journal of Surgery, Dec 2015
Surgical care for the aged: a retrospective cross-sectional study of a national surgical mortality audit from BMJ Open, Apr 2015
Outcomes from the Northern Territory Audit of Surgical Mortality: Aboriginal deaths
from ANZ J Surg, Nov 2014
Mortality Audit of Octogenarians With Acute Cholecystitis from ANZ J Surg, Aug 2014
Mortality from acute appendicitis is associated with complex disease and co-morbidity from ANZ J Surg, Jul 2014
Teleconference fracture clinics: a trial for rural hospitals by J North (PDF 934KB)
Analysis of the causes and effects of delay before diagnosis using surgical mortality data from British Journal of Surgery, Dec 2012

Qualified Privilege

Read about qualified privilege (members only)

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 195KB) to the RAAS Director, Wendy.Babidge@surgeons.org for national data extraction. Alternatively contact the QASM Project Manager for QASM data extracts.

Links

American Journal of Public Health
American Journal of Surgery
Annals of Surgery
Annals of Thoracic Surgery
ANZ Journal of Surgery
Anaesthesia
Archives of Surgery
Australian Prescriber
British Journal of Surgery
British Medical Journal (BMJ)
Canadian Journal of Surgery
European Journal of Vascular and Endovascular Surgery
Healthcare Quarterly
Intensive Care Medicine
International Journal of Public Health
International Journal of Surgery
Journal of the American Medical Association (JAMA)
Journal of Telemedicine and Telecare
Journal of Thoracic & Cardiovascular Surgery
Journal of Trauma
Journal of Vascular Surgery

Medical Journal of Australia
New England Journal of Medicine
Rural and Remote Health
Telemedicine Journal of EHealth

General links

Science Direct
American Medical Association (AMA)
Wiley
Highwire Press
Sage Publications

Seminars

Future events

Future events will be posted here. 

Previous events

QASM Seminar  on Friday, 18 November 2016, "The elderly surgical patient - evidence based practice".  

Program (PDF 398 kb)

Presentations and video's for this seminar can be dowloaded below:

Dr John North - The QASM experience with elderly patients (PDF 1,422 kb) video

Mr Philip Truskett - Surgical quality and professionalism (PDF 1,905 kb) video

Dr Trevor Fayers - Evolution of cardiac surgery in the last three decades (PDF 6,686 kb) video 

Dr Allan Kruger - Individualising aortic aneurysm management (PDF 4,882 kb) video

Associate Prof Lindy Jeffree - Blunt head trauma in the elderly (PDF 699 kb) video

Dr Will Cairns - Making end of life quality care available to all (PDF 2,750 kb) video

Prof Ian Harris - Orthopaedic interventions in older patients (PDF 3,082 kb) video

Dr Craig Harris - Malignant colonic obstructions (PDF 2,240 kb) video

Dr Jason Pincus - Intensive care and the elderly surgical patient (PDF 945 kb) video

Dr Rachel Esler - Confounders in the elderly urological patient (PDF 551 kb) video

Dr Russell J. Bourne - When not to operate (PDF 649 kb) video

Therese Rey-Conde - QASM: ten years and counting (PDF 656 kb) video

 

QASM Seminar on Friday, 13 November 2015, "Surgery and the Obese Patient". Download  program (PDF 289KB).
QASM Seminar on 7 November 2014, "Situational Awareness and the Surgeon". Download program (PDF 337KB). Presentation by Prof M Griggs on "Situational Awareness in Surgery". Download presentation (PDF 289KB).
QASM Seminar on 15 November 2013, QASM Adverse Event "Systems or surgeons?" Download program (PDF 73KB).
QASM Seminar on 9 November 2012, "Complex decision making in modern practices". Download program (PDF 67KB).
QASM Seminar on November 2011, "Queensland surgical dilemmas: distance, delays and deteriorating patients". Download report (PDF 151KB).

Contact

All general enquiries can be directed to:
QASM - Royal Australasian College of Surgeons
PO Box 7476
East Brisbane QLD 4169 Australia

Telephone: +61 7 3249 2903
Facsimile: +61 7 3391 7915
Email: qasm@surgeons.org

Project Manager - Therese Rey-Conde
Clinical Director - Dr John North
Project Officer - Sonya Faint
Project Officer - Jenny Allen
Project Officer - Candice Postin
Administrative Officer - Kyrsty Webb
Darwin Contact - Gayle Eccles

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