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5. Introduction
5.1 About the VASM
The VASM is part of the ANZASM, a national network of regionally-based audits of surgical mortality that aim to
ensure the highest standard of safe and comprehensive surgical care. VASM is a collaboration between the Victorian
Government's Department of Health and Human Services (DHHS), the Victorian Surgical Consultative Council and the
Royal Australasian College of Surgeons (RACS), The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists (RANZCOG) and The Australian Orthopaedic Association (AOA). The VASM project is funded by the
health service programs branch of the Victorian department of health to review all deaths associated with surgical care
and ascertain the adverse outcomes that were preventable. See Figure 1 in the accompanying 2015 VASM Technical
Report for more information relating to the governance of the VASM.
5.2 Objectives
The objective of the audit is to identify preventable or contributing factors associated with surgical mortality through a
peer review process that reviews all deaths associated with surgical care. The audit is a patient safety and quality
initiative designed to highlight trends in deficiencies of care and system issues, and has a focus on education and
performance improvement.
5.3 Audit process
The VASM reviews notifications of deaths that have occurred within 30 days of a surgical procedure and in the same
admission. The VASM audit does not include morbidity cases.
Individual regional audits of surgical mortality are notified of in-hospital deaths associated with surgical care. The
mortality notifications in Victoria are submitted by hospitals, coroner e-depositions, or directly from the treating
surgeon. All cases in which a surgeon was responsible for, or had significant involvement in, the care of a patient are
within the scope of the audit, whether or not the patient underwent a surgical procedure. The audit includes deaths
that occur in a Victorian hospital when:
•
an operation was performed by a surgeon, regardless of who admitted the patient
•
the patient was under the care of a surgeon and no operation was performed.
If a case does not fulfil either of the above-listed criteria it is excluded from the audit by the notifying hospital or by
audit staff. Deaths identified by the reporting surgeon as terminal care cases are recorded, but these are excluded
from further assessment in the audit. Terminal care is nominated by the surgeon on the surgical case form (SCF) and
cannot be identified from the notification of death information received by the audit of surgical mortality office.
Clinical details pertaining to the management of each case are recorded on a standard, structured SCF completed by
the consultant or treating surgeon associated with the case. The completed SCF is submitted to the audit office, and
the information de-identified and sent for first-line assessment (FLA) by a surgeon from a different hospital with the
same surgical specialty. The first-line assessor is unaware of the name of the deceased, the treating surgeon or the
hospital in which the death occurred.
There are two possible outcomes of the FLA.
•
The information provided by the treating surgeon is adequate to reach a conclusion about the case
and to identify issues of clinical management, if present.
•
A further in-depth assessment (second-line assessment [SLA] or case note review) is necessary
either:
•
for clarification of issues of patient management identified or suspected by the first-line
assessor, or
•
because the information provided by the treating surgeon was inadequate to reach a
conclusion.
Where an SLA is deemed necessary, assessors are selected using the same criteria as for first-line assessors. The
reports provided by the assessors are returned to the treating surgeon, together with a feedback form so that the
treating surgeon can “assess the assessors”. The feedback form contains a free-text field in which the treating
surgeon can expand on points raised in the assessment. This allows the treating surgeon to provide accurate clinical
details of the treated patient. Any updates received from the treating surgeon are added to the file held by the VASM.