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The CHASM Program

The CHASM Program

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Program Overview

CHASM: What is it?

The Collaborating Hospitals' Audit of Surgical Mortality (CHASM) is a systematic peer-review audit of deaths associated with surgical care. The CHASM program has the support of the NSW State Committee of the Royal Australasian College of Surgeons (RACS), the Clinical Excellence Commission (CEC) and NSW health system and is similar to audits of surgical mortality being established in Australian states.

The program is overseen in NSW by the CHASM Committee – formerly the Special Committee Investigating Deaths Associated with Surgery (SCIDAWS) – a committee of surgical peers that reports to the Minister for Health through the CEC.

CHASM is being progressively rolled out across NSW and commenced with two Area Health Services – Sydney West and Hunter New England from 1st Jan 2008.

CHASM: How does it work?

The participating surgeon may notify the CHASM office or CHASM committee directly of deaths that have occurred under his/her clinical care, irrespective of whether or not an operative procedure was carried out.
The collaborating hospital or Area Health Service will also identify eligible deaths for inclusion in the audit.
The surgical case form. The participating surgeon is contacted by the CHASM program and invited to complete the Surgical Case Form and send it to the CHASM secretariat at the CEC.
At the secretariat. All patient, hospital and surgeon identifiers are removed and the completed surgical case form is sent to a first line assessor for review. This assessor is selected on the basis that he/she is from the same surgical specialty but a different hospital as the notifying surgeon.
First-line assessment. From the information submitted on the de-identified surgical case form, an assessment is made and the appropriate documentation completed and returned to CHASM. For 80-85% of cases no further information is needed and the case details are coded and entered onto a database. The notifying surgeon will receive a confidential feedback letter from the CHASM committee on the outcome of the review.
Second-line assessment. In the 15-20% of cases where there is either insufficient detail or deficiencies of care have been identified, a second line review is requested. This comprises a full medical case note review and at this stage anonymity is no longer feasible. The participating surgeon will receive confidential and privileged feedback on their own cases from the Committee.
Other types of feedback. De identified aggregate data will be analysed by the CHASM Committee and collated into an annual report to the Minister for Health, the CEC, NSW Health and the NSW State Committee of the RACS.

CHASM: What's in it for participating surgeons?

The program will provide the participating surgeon with timely, efficient, audit and peer assessment of each death occurring under his/her clinical care.

For participating surgeons, there are opportunities to contribute to the program by:

Submitting cases for review;
Acting as a first-line assessor;
Acting as a second-line assessor to undertake detailed analysis of complex cases.

The CHASM program is supported by the Royal Australasian College of Surgeons (RACS). All participating surgeons will receive one credit point per hour for time spent on the audit. The credit points contribute to RACS Recertification (Category 3:Clinical Governance and Evaluation of Patient Care).

The participating surgeon is assured that the focus of the audit is educational and all correspondence generated in support of the audit attracts privilege under Section 23 of the NSW Health Administration Act 1982.

The program has the capacity to benefit not only surgeons and their patients but also the NSW health system. For the Area Health Service, participation by their surgeons in the program will ensure that deaths associated with surgical care have been reviewed by an independent peer surgeon in a way that meets the professional standards and expectations of the Royal Australasian College of Surgeons.

CHASM: What resources are available to support it?

The re-constituted CHASM Committee will provide a governance structure and steering group for the program. The CHASM Committee reports through the CEC to the NSW Minister for Health.

The CEC will directly employ staff to work in a central office to administer and support the program. During business hours there will be a helpdesk resource to assist participating surgeons.

In addition, the CEC will fund part-time clinical audit managers at each participating AHS to assist the clinical governance unit and local surgical leaders with case ascertainment and implementation of the program.