Mortality review is a long-recognised method of monitoring the quality of health care and is undertaken worldwide. In NSW, the Collaborating Hospitals' Audit of Surgical Mortality (CHASM) audits the 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 an education program led by surgeons for surgeons. It uses a systematic peer review methodology and provides feedback on the review findings to the treating surgeons for their consideration and learning.

The Royal Australasian College of Surgeons requires all surgeons who are in operative-based practice and have a surgical death, to participate in the Australian and New Zealand Audit of Surgical Mortality, which includes CHASM in NSW, for its Continuing Professional Development Program.


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."

Surgeon 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 note review of reported deaths.

    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 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.

    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 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. This legislative arrangement derives from the previous surgical mortality audit program in NSW - the Special Committee Investigating Deaths Associated With Surgery (SCIDAWS).