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The Clinical Excellence Commission The eChartbook


CHASMCEC Indicators CHASM
Collaborating Hospitals' Audit of Surgical Mortality (CHASM) Program
For more information about this CEC program, click here
 


Why is this important?


The Collaborating Hospitals' Audit of Surgical Mortality (CHASM) is a systematic peer-review audit of deaths of patients who were under the care of a surgeon at some time during their hospital stay in NSW, regardless of whether an operation was performed. It is overseen by a statutory committee established under s20 of the Health Administration Act 1982 (NSW), with members appointed by the Secretary, NSW Health under the delegation of the Minister for Health.


Mortality reporting is a long-recognised method of monitoring the quality of health care, and is undertaken worldwide. CHASM is designed to improve the health outcomes of surgical patients by identifying system and process errors, for ongoing improvement and educational purposes. Its audit methodology is based on the Scottish Audit of Surgical Mortality (SASM) [1], developed in 1994 and similar to other surgical mortality audits being implemented in Australia, under the Australian and New Zealand Audit of Surgical Mortality (ANZASM) framework.


CHASM is a partner of ANZASM, which is a bi-national framework of regionally-based audits of surgical mortality established by the Royal Australasian College of Surgeons (RACS). The RACS is advocating regular reporting of surgically-related mortality in all Australian States and Territories, and has made participation in ANZASM a requirement of its Continuing Professional Development Program under category one: surgical audit.


Surgeon participation in CHASM ensures that deaths reported are reviewed by an independent peer surgeon, in a way that meets the professional standards and expectations of the RACS.



References
[1] Scottish Audit of Surgical Mortality Annual Report 2010: Reporting on 2009 data. Accessed September 2013
http://www.sasm.org.uk/Publications/SASM_Annual_Report_2010.pdf


Findings


Chart CM01 presents the data on surgeon participation in CHASM, i.e. percentage of recorded deaths with completed surgical case forms (SCFs) by local health district (LHD), between 2010 and 2014. During this period, the percentage of completed SCFs returned steadily increased - from 67 to 80 per cent. The rate of SCFs returned varied widely across LHDs. The total numbers of reported deaths in NSW were around 2,000 annually, indicating an established system of notifying deaths to CHASM at most LHDs.


Chart CM02 presents the data on potentially preventable deficiency of care, i.e. percentage of audited deaths identified with potentially preventable deficiency of care. Due to the small numbers on this data at LHDs, seven years of data (2008-2014) was combined. For NSW, yearly data was presented. Over the years, the percentage of audited deaths identified with potentially preventable deficiency of care has declined – from 15 to 10 per cent. The seven-year NSW average is 13 per cent.


Implications


Each participating surgeon receives confidential feedback on the audited death that was under his or her care. In addition, CHASM produces the following publications based on the audit findings:

  • an annual casebook which identifies surgical learning and opportunities for system improvement
  • an annual individual report for each participating surgeon. This consists of the summary data of reported deaths for the surgeon during the reporting period, compared against the surgeon's peer group and against all participating surgeons in NSW
  • an annual individual program report for each participating local health district and the St Vincent Health Network, with the data compared to the NSW data against 13 clinical indicators
  • a program report which presents the NSW data by admission type against 13 clinical indicators.

What we don't know


While CHASM has the largest number of reported deaths, when compared to other similar surgical mortality audits in Australia, we do not know how complete the notification data is. CHASM is exploring options to identify the number of surgical admissions/separations for reporting surgical mortality rate in NSW.


Chart CM01 - CHASM Participation  
 

Deaths with completed surgical case forms (%), by LHD/SN and year of notification (2010-2014)

eChartbook

Source: CHASM Team, Clinical Excellence Commission.



Chart CM02 - Deaths with potentially preventable deficiency of care
 

Percentage of audited deaths with potentially preventable deficiency of care (ACONs*)
by LHD/SN and year of death (2008-2014)

eChartbook

Notes: ACON refers to clinical management issues (Area of consideration, Area of concern and Adverse event).

Source: CHASM Team, Clinical Excellence Commission.


End Matter


Contributors
Drafted by: CEC CHASM team
Data analysis by: CEC CHASM team
Reviewed by: CEC CHASM team
Edited by: CEC eChartbook team


Suggested citation
Clinical Excellence Commission [access year]. eChartbook Portal: Safety and Quality of Healthcare in New South Wales. Sydney: Clinical Excellence Commission. Available at: http://www.cec.health.nsw.gov.au/echartbook/cec-indicators-intro-chartbook/cec-indicators-chasm Accessed [insert date of access].


© Clinical Excellence Commission 2015
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Clinical Excellence Commission (CEC). Requests and enquiries concerning reproduction and rights should be directed to the Director, Corporate Services, Locked Bag 8, Haymarket NSW 1240.


Evidence-base for this initiative
Scottish Audit of Surgical Mortality (SASM)
Scottish Audit of Surgical Mortality Annual Report 2010: Reporting on 2009 data.
http://www.sasm.org.uk/Publications/SASM_Annual_Report_2010.pdf


Reported elsewhere
CHASM Annual Report


Data Definitions


Chart: CM01

Admin Status: Current, December 2014

Indicator Name: Surgeon Participation

Description: Recorded deaths with completed surgical case forms (%) by LHD/SN, 2010-2014

Dimension: Patient safety

Clinical Area: Initiatives in safety and quality health care

Numerator: Total number of returned surgical case forms (SCF)

Denominator: Total number of reported eligible surgical deaths

Data Exclusions: Number of non-surgical deaths

Data Inclusions: Number of reported eligible surgical deaths by LHD/SN

Standardisation: None

Data Source: Collaborating Hospitals' Audit of Surgical Mortality (CHASM) Program, Clinical Excellence Commission

Comments: Not Applicable
 

Chart: CM02

Admin Status: Current, December 2014

Indicator Name: Deaths with potentially preventable deficiency of care

Description: Deaths with potentially preventable deficiency of care (%) by LHD/SN, 2010-2014

Dimension: Patient safety

Clinical Area: Initiatives in safety and quality health care

Numerator: Total number of notified deaths with potentially preventable deficiency of care identified by peer assessors

Denominator: Total number of notified surgical deaths that have completed the CHASM peer review

Data Exclusions: Number of non-surgical deaths, number of notified surgical deaths related to terminal care and number of notified surgical deaths which are undergoing the CHASM peer review

Data Inclusions: Number of notified surgical deaths that have completed the CHASM peer review by LHD/SN

Standardisation: None

Data Source: Collaborating Hospitals' Audit of Surgical Mortality (CHASM) Program, Clinical Excellence Commission

Comments: Not Applicable