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2. Clinical director’s report
Learning from mortality outcomes.
This is the seventh annual report since data collection for the Victorian Audit of Surgical Mortality (VASM) commenced
on 1 July 2007. In this report we present the outcomes of the review of 10,607 deaths from 1 July 2007 to 30 June
2015. Since 2007, seven Case Note Review Booklets have been disseminated which, together with the annual
reports, have proven to be a popular tool with the surgical readership.
One hundred per cent audit participation at sites with surgical services continues across public and private hospitals in
Victoria. A total of 1,163 of the eligible 1,297 Royal Australasian College of Surgeon (RACS) Victorian surgical Fellows
are currently participating in the audit. Currently the peer review audit is limited to the following specialities General,
Colorectal, Vascular, Urology, Neurosurgery, Orthopaedic, Otolaryngology Head and Neck, Paediatric, Gynaecology,
Plastic, Cardiothoracic, Oral/maxillofacial, Ophthalmology, Trauma, Transplant and Oncology surgical services. The
scope of the current audit does not review Anaesthetic Cosmetic, Obstetrics, Cardiology, Radiology and
Gastroenterology deaths. The audits of surgical mortality have successfully expanded the program to include the
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) Fellows, and aims to
further expand its collaborations with The Victorian Consultative Council on Anaesthetic Mortality and Morbidity.
The current participation rate has increased to 89.6% in 2014 - 2015 is encouraging, and was anticipated due to the
educational value and the compulsory status of Australian and New Zealand Audit of Surgical Mortality (ANZASM) for
Continuing Professional Development (CPD) compliance. Currently, 66.6% of Gynaecological Fellows and 89.5% of
Orthopaedic Fellows participate in the VASM audit, although participation is voluntary under their CPD programme.
The RACS continues to place increased emphasis on participation in the VASM as part of CPD. As a parallel process,
the Medical Board of Australia requires the ‘provision of evidence of the CPD activities Fellows have undertaken to
meet the requirements of the Board’s standard’.
(1)
This ensures that the RACS will properly discharge its CPD duties.
Clinical trends relating to clinical risk management during the audit period show overall improvements in patient
surgical care. Deep vein thrombosis (DVT) prophylaxis to reduce the likelihood of pulmonary embolus, use of critical
care facilities, fluid balance management and patient operative profile will remain crucial areas to monitor in order to
implement educational strategies from the lessons learned in this audit. Our stakeholder education program aims to
address deficiencies in clinical management and it is encouraging to note the decrease of these as progressive
reports are published.
The VASM has rolled out the second series of hospital clinical governance reports (HCGRs) in February 2016. This
report presents de-identified aggregate data to enable benchmarking and monitoring of clinical management trends
within a hospital and compare it against other participating peer-grouped hospitals, both within the region and
nationally. The HCGRs can be presented and discussed at hospital clinical governance committee meetings, audit of
surgical mortality management committee meetings, with the local health network (or similar) representative, as well
as with hospital quality managers and Department of Health and Human Services (DHHS) representatives. DHHS
received these reports for educational performance monitoring and improvement purposes. Non-participation of
Fellows and poorly completed forms will hinder the value of these quality assurance reports sent out to hospitals.
Implementation of the electronic Fellows interface as the primary method for submission of patient data will occur
during the course of 2016 and this will help alleviate the current deficiencies associated with illegible and incomplete