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6. Audit participation and audit processes
Audit numbers
6.1.
The VASM received 10,607 notifications of deaths that have been associated with surgical care from its
commencement on 1 July 2007 to the end of the current audit period 30 June 2015.
It is beneficial to put these deaths into some perspective by reviewing the total number of surgical procedures
performed in Victoria over this period. VASM interrogated the Victorian Admitted Episodes Dataset (VAED), and
during the audit period a total of 4,920,844 patients underwent surgical procedures in Victoria.
It should be noted that a small percentage of reported deaths emanate from the private sector. The private sector
accounted for 991 of the 6,179 total cases audited from July 2007 to June 2015 (16.1%). This is predictable from the
known casemix of the two sectors. Differences in risk profiles between the two sectors are because critically ill
patients and higher risk patients are being seen in the public hospital system which provides the majority of critical
care services.
VAED indicated that in a single year (1 July 2014 to 30 June 2015) 672,957 patients underwent surgical procedures in
both the public and private sector. Of the 1,966 surgical mortality cases identified by VAED, 1,681 were reported to
VASM (85.5%).
Table 1: Audit numbers over sequential audit periods.
Case status
2007-2012
2012-2013
2013-2014
2014-2015
Audit period
Closed
3,400 (59.1%)
987 (63.4%)
1,016 (63.0%)
776 (46.2%)
6,179 (58.3%)
Non-participant
1,061 (18.4%)
141 (9.1%)
145 (9.0%)
55 (3.3%)
1,402 (13.2%)
Reported in error
239 (4.2%)
42 (2.7%)
63 (3.9%)
67 (4.0%)
411 (3.9%)
Terminal care
486 (8.4%)
185 (11.9%)
220 (13.6%)
240 (14.3%)
1,131 (10.7%)
Lost to follow-up
565 (9.8%)
190 (12.2%)
76 (4.7%)
5 (0.3%)
836 (7.9%)
Pending cases (SCF/FLA/SLA)
4 (0.1%)
13 (0.8%)
93 (5.8%)
538 (32.0%)
648 (6.1%)
All cases
5,755 (100%)
1,558 (100%)
1,613 (100%)
1,681 (100%)
10,607 (100%)
Note: n=10,607.
Audit period 1 July 2007 to 30 June 2015.
SCF: surgical case form; FLA: first-line assessment; SLA: second-line assessment.
Comments:
•
The process review backlog is the reason the most recent reporting period (2014-2015) has the highest number of
pending cases, at 32% (538/1,681). This pool of cases will be included in the analysis of future reports. The time
frame given for each step of the audit process (SCF, FLA and SLA return) is 21 working days. Obtaining medical
records and undergoing documentation de-identification processes can take up to 6 months at times for complex
cases. The compulsory status of Australian and New Zealand Audit of Surgical Mortality (ANZASM) for Continuing
Professional Development (CPD) compliance will further reduce processing backlogs.
•
The VASM’s goal is to review all mortality cases within three months of notification. The specialties with the
highest casemix were General Surgery, Orthopaedic and Neurosurgery, Vascular Surgery and Cardiothoracic
Surgery. Clinical information and completed assessment reviews were available on 58.3% (6,179/10,607) of
reported cases.
61.8%
Audit process complete
2007-2014
46.2%
Audit process complete
2014-2015