Frequently asked questions
Electronic platform - Fellows
Submission for Data Request
Case Note Review
Committee Meeting Dates
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
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.
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.
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 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 scheme.
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 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, to provide 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.
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.
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:
- 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.
- Completed case record forms are returned to the VASM
- All identifying information is removed from the form.
- 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.
- 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.
- If no further review is felt necessary, the treating surgeon
will receive feedback to this effect and the case will be
- 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
- 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
- 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
How will VASM know if a patient has died under my
VASM will be notified by the hospital's medical records department
or the Coroner's Office. 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 an easy way for me to retrieve
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
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
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
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
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 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
Third Party Delegation - Fellows User Guide
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
VASM Annual Report 2017 Media Release (PDF
VASM Annual Report 2016 Media Release (PDF 42KB)
VASM Annual Report 2015 Media Release (PDF
VASM Annual Report 2014 Media Release (PDF
VASM Annual Report 2013 Media Release
VASM Annual Report 2012 Media Release (PDF 34KB)
VASM Annual Report 2011 Media Release
Plain language statement & Executive summary
VASM Annual Report 2017 Consumer Information
VASM Annual Report 2017 Executive Summary (PDF 406KB)
VASM Annual Report 2016 Executive Summary (PDF 202KB)
VASM Annual Report 2015 Plain Language
Statement (PDF 622KB)
VASM Annual Report 2014 Plain Language
Statement (PDF 961KB)
VASM Annual Report 2017 (PDF 3.1MB)
VASM Technical Report 2017 (PDF 3.4MB)
VASM Annual Report 2016 (PDF 1.3MB)
VASM Technical Report 2016 (PDF 1MB)
VASM Annual Report 2015 (eBook)
VASM Annual Report 2015 (PDF 3.3MB)
VASM Technical Report 2015 (PDF 770KB)
VASM Annual Report 2014 (PDF 1.6MB)
VASM Annual Report 2013 (PDF 2.8MB)
Annual Report Summary 2012 (PDF 6.3MB)
VASM Annual Report
2012 (PDF 12.7MB)
Annual Report Summary 2011 (PDF 782KB)
VASM Annual Report
2011 (PDF 3.1MB)
Annual Report Summary 2010 (PDF 2MB)
VASM Annual Report
2010 (PDF 104MB)
VASM Annual Report
2009 (PDF 1.8MB)
Report 2008 (PDF 2.6MB)
VASM Annual Report
2008 (PDF 1.9MB)
VASM Assessor Feedback Survey (PDF 11KB)
2017 VASM Activity Survey - Fellows (PDF
2017 VASM Activity Survey - Hospitals (PDF
Validation of data submitted by the treating
surgeon in the VASM ANZ Journal of Surgery, November 2018.
Overview of surgical death investigations: could a dreaded
experience be turned into an opportunity? ANZ Journal of
Surgery, October 2017.
Potentially preventable deaths in the Victorian Audit of Surgical
Mortality ANZ Journal of Surgery, October 2016.
Comparison of the Victorian Audit of Surgical
Mortality with coronial cause of death ANZ Journal of Surgery,
Clinical management issues vary by specialty in the
VASM: a retrospective observational study BMJ Open, June
VASM is associated with improved clinical
outcomes ANZ Journal of Surgery, June 2014.
Evaluating the value and impact of VASM ANZ
Journal of Surgery, June 2013.
evaluation survey report 2011 (PDF 653KB)
evaluation survey report 2010 (PDF 534KB)
ASPEX Evaluation Report on VASM Dec 2018 (PDF
ASPEX Evaluation Report on VASM July 2015
Evaluation Report on VASM Nov 2011 (PDF 1.3MB)
VASM Validation Audit Report FLA 2017 (PDF
VASM Validation Audit Report SLA 2013 (PDF 892KB)
VASM Validation Audit Report FLA 2013 (PDF
Previous issues see
Interface User Guide (PDF 2.1MB)
Case Note Review Booklet
Edition 10 (PDF 1.4MB)
Edition 9 (PDF 1.3MB)
Edition 8 (eBook)
Edition 8 (PDF 1.9MB)
Edition 7 (PDF 481KB)
Edition 6 (PDF 3.9MB)
Edition 5 (PDF 2MB)
Edition 4 (PDF 7.6MB)
Edition 3 (PDF 8MB)
Edition 2 (PDF 3.2MB)
Edition 1 (PDF 759KB)
Go to ANZASM for the National Case Note Review Booklets
Case of the Month
Issue 3 (August 2018)
Issue 2 (July 2018)
Issue 1 (June 2018)
Positive Assessments Booklet
Edition 1 (PDF 3.5 MB)
Issue 27, Aug 2018 (eNews)
Issue 26, May 2018 (eNews)
Issue 25, Dec 2017 (eNews)
Issue 24, Sept 2017 (eNews)
Issue 23, June 2017 (eNews)
Issue 22, Apr 2017 (eNews)
Previous issues see
Process Timeline (PDF 24KB)
A Guide for
Victorian Hospitals (PDF 1MB)
De-id Guideline for Hospitals (PDF 618KB)
first and second line assessors (PDF 1MB)
Consultant Participation Form - RACS
Consultant Participation Form - RANZCOG
Notification of Death
(NOD) Form (PDF 1.2MB)
Case Record Form (CRF) (PDF 737KB)
Case Record Form
Functional Definitions (PDF 138KB)
First Line Assessment (FLA) Form
First Line Assessment Functional Definitions
Second Line Assessment (SLA) Form
Second Line Assement Functional Definitions
Data Request Form (PDF 1.1MB)
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.
Joint Replacement Registry
Health & Research Data Managers Association
Australasian Society for Cardiac and Thoracic
and New Zealand College of Anaesthetists (ANZCA)
New Zealand Intensive Care Society (ANZICS)
New Zealand Society for Vascular Surgery (ANZSVS)
of Health, Victoria, Australia
Health Issues Centre
E-Health Transition Authority
Australasian College of Medical Administrators
State Coroners Office of Victoria
Victorian Admitted Episodes Data Set
Victorian State Trauma Registry
Victorian Surgical Consultative Council
Seminar, 20 February 2019 on "Surgical Safety 'how to
engage wholly' for success" to be held at the Training Room, Royal
Australasian College of Surgeons. Register online and download the program (PDF 61K).
VASM Workshop, 19 October 2018 on "Lessons learnt from
the VASM audit". This seminar will be held between 1.30pm - 4.30pm
at the Royal Children's Hospitals, Parkville, VIC 3052. Download report (PDF 51KB).
Presentations for this seminar
can be downloaded below:
Mr Philip McCahy, Lessons learnt from the VASM Audit: Peer review
assessment (PDF 693KB)
Cornelissen, Human factors VASM and system safety in incident
investigation (PDF 992KB)
Legal issues for surgical audits (PDF
VASM Workshop, 5 September 2018 on "Can the VASM audit
improve patient outcomes? - A regional perspective". Download report (PDF 61KB).
Presentations for this workshop can be downloaded below:
Ms Claudia Retegan, An overview of the VASM audit (PDF 1.2MB)
Mr Philip McCahy, From sad to bad patient journeys (PDF
Ms Glenda Gorrie, Quality and safety improvement in healthcare
Mr Peter Burke, A regional perspective to improve patient
outcomes (PDF 5.4MB)
,12 July 2018, "Unexpected death - What now?". Download report (PDF 49KB)
14 February 2018 on "The journey to Target Zero - tools to adress
critical areas that require improvement". Download report (PDF 61K).
Presentations for this seminar can be downloaded and watched
Prof Stephen Duckett, Improving surgical quality and safety: what is the
evidence? (PDF 2.5MB). Watch here.
Prof Euan Wallace, Target Zero recommendation action plan (PDF
2.1MB). Watch here.
Dr Andrea Kattula, Avoidable causes of morbidity and mortality
related to anaesthesia (PDF 216KB).
Mr Trevor Jones, Avoidable causes of morbidity and mortality
related to surgery (PDF 111KB). Watch
Ms Claudia Retegan, VASM tools to address critical areas that require
improvements (PDF 1.3MB). Watch
Prof David Watters, Hospital performance reports and governance
reports - Inner regional heath services perspective (PDF
1.9MB). Watch here.
Prof Rodney Judson, A trauma center perspective to assessing
performance (PDF 2.4MB). Watch here.
Dr Lee Hamley, Benefits and challenges of a positive outlier - A
major metropolitan health service perspective (PDF 487KB). Watch
Mr Steven McConchie, Private versus public hospital performance - The
private sector perspective (PDF 443KB). Watch
Mr Philip McCahy, Closing the quality improvement loop (PDF
1.2MB). Watch here.
Panel discussion. Watch
27 September 2017, "Fellows Interface Workshop". Download report (PDF 29KB).
VASM AHRDMA Annual Scientific
16 June 2017, "Knowledge-based sharing in the health
industry". Download report (PDF 52KB).
Seminar, 21 February
2017, "Can registries and audits improve patient outcomes?". Download report (PDF 49KB).
Workshop,21 October 2016, "Lessons learned from
the VASM cases". Download report (PDF 41KB).
2016, "Would you have changed the management of this patient's
course to death?" Download report (PDF
VASM Seminar,23 February 2016, "Improving
outcomes in the surgical patient". Download report (PDF 95KB).
October 2015, "Would you have changed the management of this
patient's course to death?" Download report (PDF 56KB).
VASM Seminar,18 February 2015, "Perioperative
care. How can we do better?" Download report (PDF 73KB).
VASM Workshop,1 May 2014, "Understanding the
literature and preparing for journal submission". Download report (PDF 134KB).
VASM Seminar,19 February 2014, "Surgical
Emergencies and Shared Care".
Download report (PDF 33KB).
Expansions in the surgical mortality audits include the
collaboration between the VASM and the Victorian Consultative
Council on Anaesthetic Mortality and Morbidity (VCCAMM).
The state-wide monitoring and reporting of anaesthesia-related
mortality and morbidity by the VCCAMM is based on the voluntary
submission of direct reports from treating anaesthetists, or
indirect reports from other medical practitioners or hospital
anaesthetic departments and now from the VASM.
The VASM identifies a potential anaesthetic component to the
death of the patient from Q17 ("Was there an anaesthetic
component to the patient death?") from the SCF as
answered by the treating surgeon. If the answer to the
question is "Yes" or "Possibly" then the VASM refers the cases on a
monthly basis to the VCCAMM for a further anaesthetic assessment.
This process is fully covered by the ANZASM Qualified Privilege
(gazetted 25th July 2016).
In the event of an
anaesthesia-related death, a detailed list of documentation is then
to be forwarded by the hospital to the VCCAMM within 28
Upon completion of the anaesthesia-related death assessment,
relevant stakeholders are provided the findings of the inquest
according to the VCCAMM guidelines. During this process, the VASM
is provided with a copy of the final anaesthetic assessment to
close the audit loop.
Developments in the surgical mortality audits comprise the
inclusion of our Gynaecological colleagues into VASM with a
steadily increasing number of participants. 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.
All general enquiries can be directed to:
VASM - Royal Australasian College of Surgeons
GPO Box 2821
Melbourne VIC 3001 Australia
Telephone: +61 3 9249 1154
Fax: +61 3 9249 1130
Clinical Director - Associate Professor Philip James
Project Manager - Claudia Retegan
Senior Project Officer - Jessele Vinluan
Project Officer - Andrew Chen
Research Assistant - Dylan Hansen
Research Assistant - Ushan Vithanage
Officer - Laura Varanelli
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