Programs CHASM - Collaborating Hospitals' Audit of Surgical Mortality
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.
CHASM is funded by NSW Health, administered by the CEC and co-managed by the NSW State Committee of the Royal Australasian College of Surgeons (RACS). Its audit methodology is based on the Scottish Audit of Surgical Mortality, developed in 1994. It is similar to the 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 RACS.
All surgeons in NSW are welcome to participate.
- Notification of deaths. Clinical audit managers (CAMs) or their equivalents at local health districts (LHDs) provide fortnightly or monthly notifications of surgical deaths to CHASM. CHASM then sends a self-administered questionnaire (SCF) to the consultant surgeon to request information about the death. Consultant surgeons may notify the CHASM office directly of deaths that have occurred under their clinical care by completing a SCF, available from the CHASM office and website and from the CAM or equivalent staff at LHDs.
- At the CHASM office. All patient, hospital and surgeon identifiers on the completed SCF are removed, before the form is sent to a first-line assessor for review. The assessor is selected from the same surgical specialty, but a different LHD,as the treating consultant surgeon.
- First-line assessment. The first-line assessor makes an assessment of the reported death from the information submitted on the de-identified SCF. He/she then completes the assessment form and returns it to CHASM. For cases that do not require further information, the audit findings are coded and entered in a database. The notifying surgeon receives a confidential feedback letter from the CHASM committee on the outcome of the review.
- Second-line assessment. For cases where there is either insufficient detail, or potential deficiencies of care have been identified, a case note review is requested. This comprises a full medical case note review. At this stage anonymity is no longer feasible. The notifying surgeon receives confidential and privileged feedback from the CHASM committee, based on the assessor's comments. All second-line assessment reports are de-identified and distributed to CHASM committee members for noting.
- Other types of feedback. Each year the participating surgeon receives an individual summary of data he/she has submitted, compared against the average for the specialty and all surgeons in NSW. An annual report of de-identified aggregated data is submitted to the Minister for Health, the CEC, NSW Health and the NSW State Committee of the RACS.
- Appeal. If the surgeon is dissatisfied with the outcome of the second-line assessment, a third assessment is arranged by the CHASM chair, to further review the reported death.
Surgeons can participate in CHASM by:
- Submitting cases for review
- Acting as a first-line assessor
- Acting as a second-line assessor to undertake detailed case note review of reported deaths.
The CHASM program is supported by the Royal Australasian College of Surgeons (RACS). According to the RACS' Continuing Professional Development Manual 2010-12, it is a requirement "to participate in the Australian and New Zealand Audit of Surgical Mortality if a surgeon is in operative-based practice, has a surgical death and an audit of surgical mortality is available in the surgeon's hospital."
Participation as a first- or second-line assessor remains voluntary and is encouraged by the RACS.
All participating surgeons will receive one credit point per hour for time spent on the audit. They contribute to RACS re-certification (Category 3: Clinical Governance and Evaluation of Patient Care).
The participating surgeon is assured that the focus of the audit is educational and that all information collected for the audit attracts privilege under Section 23 of the NSW Health Administration Act 1982.
The program not only benefits surgeons and their patients, but also the NSW health system. For local health districts, participation by their surgeons in the program will ensure that deaths associated with surgical care are reviewed by an independent peer surgeon, in a way that meets the professional standards and expectations of the Royal Australasian College of Surgeons.
CHASM is overseen by a Committee, which was established under section 20 of the Health Administration Act 1982 and appointed by the Minister for Health. It is empowered with special privileges under section 23(7) of the same Act, to protect the confidentiality of the information collected for CHASM. This legislative arrangement derives from the previous surgical mortality audit program in NSW - the Special Committee Investigating Deaths Associated With Surgery (SCIDAWS).
The Terms of Reference (TOR) describe the functions of the committee.
The CHASM Committee currently consists of 19 members who were appointed by the NSW Minister for Health.
- A/Prof Michael Fearnside, AM
Chair CHASM committee
Dr Robert Costa
Deputy chair CHASM committee and chair of the NSW State Committee of RACS
- Dr Graham Beaumont
Human factors specialist
- Prof Belinda Bennett
Professor of Health and Medical Law
- Dr Allysan Armstrong-Brown
- Dr Lewis Chan
- Dr Anthony Eyers
- A/Prof John Graham
- Dr Warren Hargreaves
- Prof John Hilton
- Prof Clifford Hughes, AO
Chief Executive Officer, CEC
- Dr Michael King
- Dr Steven Leibman
- Dr Hugh Martin, AM
- Dr Charles Pain
Director Health Systems Improvement, CEC
- Dr David Robinson
- Prof Allan Spigelman
- Dr Warwick Stening
- A/Prof Peter Zelas OAM
- Participate in CHASM brochure - PDF ~672kb
- Presented at the International Forum on Quality and Safety in Healthcare in April 2012 - CHASM Poster - PDF ~2.3Mb
- Presented at the Australasian Mortality Data Interest Group Workshop in November 2011 - PDF ~1.17Mb
- Presented at the Australasian Mortality Data Interest Group Workshop in November 2010 - PDF ~510kb
The CEC has staff working in a central office (CHASM Secretariat) to administer and support the program. During business hours, there is a helpdesk service to assist participating surgeons.
Clinical Excellence Commission
Locked Bag A4062
SYDNEY SOUTH NSW 1235
+61 2 9269 5530
+61 2 9269 5599
Designated staff at LHDs notify deaths to CHASM and assist surgeons with accessing CHASM forms and patients' case notes.
Designated staff at LHDs can be contacted for enquiries relating to the program. Download
- Designated staff at LHDs contact list - PDF ~40kb