CHASM: Collaborating Hospitals’ Audit of Surgical Mortality (CHASM)

In NSW, CHASM reviews the deaths of patients within 30 days of surgery or when under the care of a surgeon during their hospital stay, regardless of whether an operation was performed.

CHASM is overseen by a committee, which was established under section 20 of the Health Administration Act 1982 with members appointed by the Secretary, NSW Health, under delegation by the Minister for Health. It is empowered with special privileges under section 23 of the same Act, to protect the confidentiality of the information collected for CHASM.

CHASM is an education program led by surgeons for surgeons. It uses a systematic peer review methodology to provide confidential feedback to surgeons for their consideration and learning.

Through the course of the peer review, both the surgeon and peer review assessor benefit from the process of reflection.

It is not the intention of the program to be performance-driven, but rather, to inform and initiate conversations that drive improvement in clinical management and future treatments.

Participation in CHASM

Surgeons can participate in CHASM by:

  • completing a self-notification electronically through Fellows Interface Link (opening in Chrome recommended)
  • submitting completed case forms for review
  • completing peer review as a first-line assessor
  • undertaking a detailed case note review as a second-line assessor
  • becoming a member of the CHASM committee.

Hospitals can participate in CHASM by:

  • submitting surgical deaths that meet the criteria stated in the Terms of Reference.

The CHASM Office will create a case profile and generate a request to the operating surgeon to complete a case form.

For hospitals, participation by surgeons in the program will ensure that deaths associated with surgical care undertake an independent peer review by a surgeon from the same specialty, with confidential feedback provided to the operating surgeon for their reflection.

History of the CHASM program

  • On 26 May 1994, the then NSW Minister for Health initiated a Special Committee Investigating Deaths Associated With Surgery (SCIDAWS). Its purpose was to collate surgical mortality data for the purpose of educating surgeons and health care providers.
  • In 2004, following recommendations from the Morey Report, SCIDAWS was transferred to the then Institute of Clinical Excellence (ICE) to improve the reporting and investigation of surgical deaths.
  • In July 2006, the functions of SCIDAWS were expanded to enable a more systematic and comprehensive audit, and included cases where no operation was performed.
  • On 7 November 2007, the then Minister for Health approved a name change – with SCIDAWS becoming CHASM – to promote the collaborative nature of the audit.
  • The Minister confirmed in Government Gazette No. 169 that special privilege provided for SCIDAWS under the Health Administration Act 1982 would apply for CHASM.