
Background
Qualified privilege
Audit process
Frequently asked questions
Electronic platform - Fellows interface
Reports and publications
Submission for Data Request
Forms
Seminars
Committee Meeting Dates
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:
- it is independent
- it is external
- it is peer-reviewed
- it is systematic
- it is routine
- it is objective
- it is confidential (all audits are covered by qualified
privilege at a Commonwealth level).
Qualified privilege
Overview
The Qualified Privilege (QP) declaration (PDF
2.1MB) 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 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:
- 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, 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
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
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:
- completed by the consultant surgeon or a registrar (under
supervision)
- returned to WAASM in the envelope provided (as soon as
possible)
- 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:
- a second-line assessor is chosen by WAASM staff based upon a
set of criteria created to minimise any selection bias
- medical records are requested
- 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
- 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
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 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
WAASM Annual Report 2018 (PDF 2.7MB)
WAASM Executive Summary 2018 (PDF 1.2MB)
WAASM Annual Report 2017 (PDF 4.73MB)
WAASM Executive Summary 2017 (PDF 1.5MB)
WAASM Annual Report 2016 (PDF 1.3MB)
WAASM Annual Report 2015 (PDF 1.2MB)
WAASM Annual Report 2014 (PDF 1MB)
WAASM Annual Report 2013 (PDF 1.5MB)
WAASM Annual Report 2012 (PDF 1.9MB)
WAASM Annual Report 2011 (PDF 3MB)
WAASM Annual Report 2010 (PDF 6MB)
WAASM Annual
Report 2009 (PDF 10MB)
WAASM Annual
Report 2008 (PDF 516KB)
WAASM Annual
Report 2007 (PDF 1MB)
WAASM Annual
Report 2006 (PDF 320KB)
WAASM Annual
Report 2004 (PDF 249KB)
Case Note Review
WAASM and
TASM - July 2018 (PDF 584KB)
WAASM
and TASM - November 2017 (PDF 614KB)
WAASM and
TASM - December 2016 (PDF
1.5MB)
WAASM and TASM - July 2016 (PDF 626KB)
WAASM and TASM - October 2015 (PDF 177KB)
WAASM and TASM - December 2014 (PDF 304KB)
WAASM and TASM - September 2013 (PDF 189KB)
WAASM and TASM - September 2012 (PDF 300KB)
WAASM and TASM - September 2011 (PDF 92KB)
WAASM
and TASM - January 2011 (PDF 79KB)
WAASM and TASM - December 2009 (PDF
102KB)
WAASM and TASM - August 2009 (PDF 65KB)
WAASM and TASM - April 2008 (PDF
161KB)
WAASM and TASM - April 2007 (PDF 184KB)
WAASM and TASM - August 2006 (PDF 161KB)
WAASM - August 2005 (PDF 738KB)
WAASM - June 2004 (PDF 261KB)
WAASM - November 2003 (PDF 445KB)
WAASM - February 2003 (PDF 211KB)
WAASM - March 2002 (PDF 196KB)
Forms
Surgical Case Form (PDF 484KB)
Surgical Case Form - Neuro
(PDF 645KB)
First Line Assessment Form (PDF 405KB)
Second Line Assessment Form (PDF 401KB)
Data Request Form (PDF 1.1MB)
Manual
Fellows Interface
User Guide (PDF 2.1MB)
Self-generated Notification of Death User
Guide (PDF 1.1MB)
Newsletter
Read the WAASM newsletter (members only)
Consumer booklet
WAASM consumer booklet (PDF
332KB)
Links
School of
Population Health (CHSR)
Department of Health, Western Australia
Clinical Training and Education Centre
(CTEC)
National
Confidential Enquiry into Patient Outcome and Death
(NCEPOD)
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
Future events will be posted here.
Previous events
WAASM Symposium, Thursday, 24 August
2017, "The Perth Emergency Laparotomy Audit - Where to Now?". Download report
(PDF 967KB)
Presentations as follows:
Mr James Aitken, National Australian data in an international
context, watch video
Dr Peter Pockney, Emergency laparotomy audit in NSW, watch
video
Dr Claire Stevens, Outcome of emergency laparotomy in Victoria -
Dr Foster's diagnosis, watch video
Dr Mary Theophilus, A hospital's response, watch
video
A/Prof David Mountain, An emergency department's response, watch
video
Prof Marina Wallace, Who should operate on emergency laparotomies,
watch
video
Dr Audrey Koay, What a Department of Health would want from a
national audit, watch video
Prof David Fletcher, A proposed Australian and New Zealand
emergency laparotomy audit, watch video
Prof Guy Maddern, Concluding discussion, watch
video
WAASM
Symposium, Tuesday, 15 November 2016, "Futile Care
and End of Life Matters". Download report (PDF 795KB)
Presentations as follows:
Prof James Aitken Introduction - Futile Care and End of Life
Matters (PDF 625KB), watch video.
Hon Jim McGinty AM Parliament's Role in End of Life
Matters (PDF 203KB), watch
video.
Dr Penny Flett The Aged Care Sector's Role In Preparing For The
End Of Life (PDF 356KB)
watch video.
Dr Matthew Anstey End of Life Care - National Policy
Perspective (PDF 1.2MB),
watch video.
Dr Tim Paterson Fifty fifty Doc? Proceeding in Borderline
Cases (PDF 815KB), watch video.
Mr Stephen Honeybul
Futile Care or No Treatment (PDF 10.6 MB), watch video.
Dr Zaza Lyons and Mr Albie
Lyons Futility Recovery Personal
Reflection (PDF 1.9MB),
watch video.
Panel discussion,
watch video.
WAASM Symposium, 31 August 2015, "Transferring Surgical
Patients: better organisation is required", Harry Perkins Institute
of Medical Research (QEII), Perth. Download the program (PDF 107KB). For more
information email the WAASM office.
WAASM Symposium, February 2011, "Recognising
the Deteriorating Patient". For a copy of audio/video file email the WAASM office.
Contact
All general enquiries can be directed to:
WA Audit of Surgical Mortality (WAASM)
Post: M308, University of Western Australia, Crawley WA 6009
Street: 184 Hampden Road, Nedlands WA 6009
Telephone: +61 8 6389 8650
Fax: +61 8 6389 8655
Email: waasm@surgeons.org
Clinical Director - Mr James Aitken
Project Manager - Franca Itotoh
Senior Project Officer - Natalie Zorbas-Connell
Project Officer - Sonya Furneyvall
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