Collaborating Hospitals’ Audit of Surgical Mortality (CHASM)

Aim

To improve the quality and safety of surgical care in NSW hospitals. To reduce the number of preventable surgical deaths in NSW hospitals.

Benefits

All surgeons who are in operative practice are required to report the clinical management of their patients who die while under their care to CHASM for peer review. CHASM provides feedback on the peer review findings to surgeons to facilitate reflective learning and improvement in surgical care.

Summary

CHASM reviews deaths of patients who were under the care of a surgeon, or where a surgeon had major input to care, irrespective of whether or not an operation was performed. Each patient death is reviewed by an anonymous peer surgeon. If there are questions or concerns, a second and more detailed case notes review will be undertaken. The peer review aims to identify any system and process errors in the management of the patient. CHASM provides feedback on the peer review findings to surgeons to facilitate reflective learning and improvement in surgical care.

Background

CHASM reviews deaths of patients who were under the care of a surgeon, or where a surgeon had major input to care, irrespective of whether or not an operation was performed.

Each patient death is reviewed by an anonymous peer surgeon. If there are questions or concerns, a second and more detailed case notes review will be undertaken.

Participation in CHASM is a requirement of the Continuing Professional Development Program (CPD) of the Royal Australasian College of Surgeons (RACS). Surgeons who had a death under their care in NSW, are required to participate by completing details of the death in the surgical form for review by CHASM.

All information collected by CHASM have special privilege under section 23 of the Health Administration Act 1982 to enable robust discussion on the clinical management of the patient.

Participation as a surgical assessor is voluntary and is encouraged by RACS through CPD points.

CHASM provides feedback on the audit findings to surgeons to facilitate reflective learning and improvement in surgical care.

CHASM also produces various publications including:

  • an annual report on program participation and audit findings
  • a casebook that features the surgical learnings of selected cases
  • an annual individualised report to participating surgeons
  • an annual individualised local health district report on its performance against 13 program indicators.

Partnerships

CHASM is funded by NSW Health, administered by the Clinical Excellence Commission (CEC), and co-managed with the NSW State Committee of the Royal Australasian College of Surgeons (RACS).

CHASM is also a partner of the Australian and New Zealand Audit of Surgical Mortality, which is the bi-national framework of regionally based audits of surgical mortality administered by the RACS.

The following LHDs and private hospitals are participating in CHASM by providing regular notifications and medical records for case review to CHASM:

  • Central Coast
  • Far West
  • Hunter New England
  • Illawarra Shoalhaven
  • Mid North Coast
  • Murrumbidgee
  • Nepean Blue Mountains
  • Northern NSW
  • Northern Sydney
  • South Eastern Sydney
  • South Western Sydney
  • Southern NSW
  • St Vincent's Health
  • Sydney
  • Western NSW
  • Western Sydney
  • Sydney Children's Hospitals Network
  • North Shore Private Hospital
  • Strathfield Private Hospital
  • Sydney Private Hospital
  • St George Private Hospital
  • Sydney Adventist Hospital
  • St Luke’s Hospital, Darlinghurst
  • St Vincent's Private Hospital
  • St Vincent's Private Hospital, Lismore
  • Macquarie University Hospital
  • The Mater Private Hospital

Key Dates

CHASM produces its annual publications between September and December. Copies of these publications are distributed to all surgical fellows and trainees in NSW and the local health districts participating in CHASM.

Pilot Sites

CHASM commenced data collection at the former Western Sydney Area Health Service and Hunter New England Area Health Services in January 2008. Now rolled out across the state.

Hunter New England Local Health DistrictHunter New England Local Health DistrictCommenced data collection
Western Sydney Local Health DistrictWestern Sydney Local Health DistrictCommenced data collection

Implementation Sites

CHASM has been implemented in all NSW public hospitals since 2009. It is being promoted to private hospitals in NSW.

Central Coast Local Health DistrictCentral Coast Local Health District
Far West Local Health DistrictFar West Local Health District
Hunter New England Local Health DistrictHunter New England Local Health District
Illawarra Shoalhaven Local Health DistrictIllawarra Shoalhaven Local Health District
Mid North Coast Local Health DistrictMid North Coast Local Health District
Murrumbidgee Local Health DistrictMurrumbidgee Local Health District
Nepean Blue Mountains Local Health DistrictNepean Blue Mountains Local Health District
Northern NSW Local Health DistrictNorthern NSW Local Health District
Northern Sydney Local Health DistrictNorthern Sydney Local Health District
South Eastern Sydney Local Health DistrictSouth Eastern Sydney Local Health District
South Western Sydney Local Health DistrictSouth Western Sydney Local Health District
Southern NSW Local Health DistrictSouthern NSW Local Health District
St Vincent's Health NetworkSt Vincent's Health Network
Sydney Children's Hospital NetworkSydney Children's Hospitals Specialty Network
Sydney Local Health DistrictSydney Local Health District
Western NSW Local Health DistrictWestern NSW Local Health District
Western Sydney Local Health DistrictWestern Sydney Local Health District

Evaluation

A survey was conducted in 2010 to assess surgeons’ participation experience and identify areas for improvement. The survey findings were published in the newsletter of the NSW Chairman of RACS.

LHD participation data are reported monthly to the senior executives.

An individualized program report was published for each participating local health district in July 2013. The report presents the local health district’s participation data and its performance against 13 clinical indicators between 2008 and 2012.

Related Initiatives

CHASM shares its confidential information with the Special Committee Investigating Deaths Under Anaesthesia.

Further Details

For more information about CHASM, including its peer review methodology, program governance and publications, please visit CHASM - Collaborating Hospitals' Audit of Surgical Mortality on the CEC website.

Contact

Paula Cheng
Manager, Special Committees
paula.cheng@health.nsw.gov.au
(02) 9269 5543

Prof Peter Zelas OAM
Chair, CHASM
chasm@cec.health.nsw.gov.au

Page Top | Added: 30 October 2013 | Last modified: 30 May 2014

CEC
Status:
Contact:
Paula Cheng
Manager, Special Committees
Email
(02) 9269 5543
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