All surgeons in NSW are welcome to participate.

How does it work?

1. Notification of deaths. Clinical Audit Managers (CAM) or their equivalents at Local Health Districts (LHD) 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 his/her clinical care by completing a SCF, which is available from the CHASM office, CHASM website and from CAM or equivalent staff at LHD.
2. 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. This assessor is selected from the same surgical specialty but a different LHD as the treating consultant surgeon.
3. 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.
4. 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 and 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.
5. 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.
6. Appeal. If the surgeon is dissatisfied with the outcome of the second line assessment, a third assessment is arranged by the Chairman to further review the reported death.

Program Participation

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 notes review of reported deaths.

The CHASM program is supported by the Royal Australasian College of Surgeons (RACS). According to the Royal Australasian College of Surgeons' 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 encouraged by the College.

All participating surgeons will receive one credit point per hour for time spent on the audit. The credit points contribute to RACS Recertification (Category3: Clinical Governance and Evaluation of Patient Care).

The participating surgeon is assured that the focus of the audit is educational and all information collected for the audit attracts privilege under Section 23 of the NSW Health Administration Act 1982.

The program will benefit not only surgeons and their patients but also the NSW health system. For Local Health Districts, participation by their surgeons in the program will ensure 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.

The CHASM Committee

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. The Committee 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 (Special Committee Investigating Deaths Associated With Surgery (SCIDAWS).

The Terms of Reference (TOR) describes the functions of the Committee.

The CHASM Committee currently consists of 21 members who were appointed by the NSW Minister for Health:

• A/Prof Michael Fearnside AM
  Chairman CHASM Committee
• Dr Joseph Lizzio
  Deputy Chair CHASM, NSW State Committee Chair RACS
• Dr. Graham Beaumont
  Human Factors Specialist
• Prof Belinda Bennett
  Professor of Health and Medical Law
• Dr Allysan Armstrong-Brown
  Anaesthetist
• Dr Lewis Chan
  Urologist
• Dr Anthony Eyers
  Colorectal Surgeon
• Dr Warren Hargreaves
  General Surgeon
• Prof John Hilton
  Forensic Pathologist
• Prof Clifford Hughes AO
  Chief Executive Officer, CEC
• Dr Michael King
  General Surgeon
• Dr Steven Leibman
  General surgeon
• Dr Hugh Martin AM
  Paediatric Surgeon
• Dr Charles Pain
  Director Health Systems Improvement, CEC
• Dr David Robinson
  Vascular Surgeon
• Prof Allan Spigelman
  Surgical Oncologist
• Dr Warwick Stening
  Neurosurgeon
• A/Prof Peter Zelas OAM
  Colorectal Surgeon

Brochures

• Participate in CHASM brochure - PDF ~301kb

Posters

• 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

Forms

• CHASM Surgeon Participation Form - PDF ~840kb
• CHASM Surgical Case Form - PDF ~106kb
• CHASM First Line Assessor's Form - PDF ~106kb
• CHASM Second Line Assessor's Form - PDF ~133kb

CHASM Casebook 2011

This casebook presents the summaries and learnings of 15 audited cases and has a theme on the recognition and management of the deteriorating patient. 

• CHASM Casebook 2011 - PDF ~3.1Mb |

CHASM Casebook: July 2009 - June 2010

This casebook discusses the events and learnings of 14 audited cases, with a theme on venous thromboembolism prophylaxis.

• CHASM Casebook 2009 - 2010 - PDF ~2.0mb | TXT ~68kb

CHASM Case Booklet: January 2008 - June 2009

This casebook publishes the summaries and learnings of 11 audited cases, with a theme on aspiration pneumonitis.

• CHASM Case Booklet 2008 - 2009 - PDF ~2.20mb | TXT ~30kb

Individual Report to a Participating Surgeon (Sample)

This is a fictitious example of an individual report that was sent to surgeons, who returned a completed surgical case form to CHASM during the reporting period. The report gives a summary of the data provided by the surgeon, and compares the surgeon's data with aggregated data of the surgeon's peers in the same surgical specialty, as well as NSW surgeons in all specialties.

• Individual Report To a Participating Surgeon July 2009 to June 2010 - PDF ~630kb
• Individual Report To A Participating Surgeon January 2008 to June 2009 - PDF ~350kb
• Frequently Asked Questions relating to the Individual Report - PDF ~35kb

CHASM Secretariat

The CEC has employed 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.

Postal:

CHASM Secretariat
Clinical Excellence Commission
Locked Bag A4062
SYDNEY SOUTH NSW 1235

Telephone:

+61 2 9269 5530

Fax:

+61 2 9269 5599

Email:

chasm@cec.health.nsw.gov.au

Clinical Audit Managers

Clinical Audit Managers or their equivalents are located at Local Health Districts to notify deaths to CHASM and assist local surgeons with accessing CHASM forms and patients' case notes.

Clinical Audit Managers can be contacted for enquiries relating to the program. For contact details download the:

• Clinical Audit Managers contact list - PDF ~96kb

• NSW State Committee of the Royal Australasian College of Surgeons
• Scottish Audit of Surgical Mortality (SASM)