Collaborating Hospitals' Audit of Surgical Mortality (CHASM)

Notification & Review

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 surgical case form (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 below.

There are designated staff at each LHD and specialty health network to assist local surgeons with obtaining case notes, identifying cases and liaising with the CHASM Secretariat and Committee.

The CEC also 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.    

Case Assessment and Review

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.