Programs CHASM - Collaborating Hospitals' Audit of Surgical Mortality

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 CHASM Committee currently consists of 19 members, including:

• A/Prof Michael Fearnside AM
  Chair CHASM Committee
• Dr Peter Holman
  Deputy Chair CHASM, NSW State Committee Chair RACS
• Dr Allysan Armstrong-Brown
  Anaesthetist
• Dr. Graham Beaumont
  Human Factors Specialist
• Prof Belinda Bennett
  Professor of Health Law
• Dr Lewis Chan
  Urologist
• Prof Stephen Deane
  General & Trauma Surgeon
• Dr Anthony Eyers
  Colorectal Surgeon
• Dr Charles Fisher
  Vascular Surgeon
• Dr Hamish Foster
  General Surgeon
• Dr Kim Hill
  Director CGU (HNEAHS)
• Dr Michael King
  General Surgeon
• Prof John Hilton
  Forensic Pathologist
• Dr Charles Pain
  Director CGU (SWAHS)
• Prof Allan Spigelman
  Surgical Oncologist
• Dr Warwick Stening
  Neurosurgeon
• Dr Mauro Vicaretti
  Vascular Surgeon
• Dr Shane Waddell
  Orthopaedic Surgeon
• A/Prof Peter Zelas OAM
  Colorectal Surgeon

All surgeons in NSW are welcome and invited to participate.

How does it work?

1. The participating surgeon may notify the CHASM office directly of deaths that have occurred under his/her clinical care, irrespective of whether or not an operative procedure was carried out.
2. The collaborating hospital or Area Health Service (AHS) will also identify eligible deaths for inclusion in the audit.
3. The surgical case form.The participating surgeon completes a Surgical Case Form to provide information about the death and returns the form to the CHASM office. The Surgical Case Form is available from the CHASM office, CHASM website and from Clinical Audit Managers at AHS.
4. At the CHASM office. 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 from the same surgical specialty but a different hospital as the notifying surgeon.
5. 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.
6. 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.
7. Other types of feedback. Each year the participating surgeon will receive an individual summary of data he/she has submitted, compared against the average for the specialty. De-identified aggregate data will be analysed by the CHASM Committee and collated into an annual report for submission to the Minister for Health, the CEC, NSW Health and the NSW State Committee of the RACS.
   

Program Participation

The program provides 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 (Category3: 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 will 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.