Evaluating the value and impact of the Victorian Audit of Surgical Mortality

Abstract

Introduction: Since the Victorian Audit of Surgical Mortality (VASM) commenced in 2007, 95% of Victorian Fellows have agreed to participate and have provided data on the deaths of patients receiving surgical care. All public, and the majority of private, hospitals involved in the delivery of surgical services in Victoria have been submitting data on deaths associated with surgery. De-identified reports on this data are distributed in regular annual reports and case note review booklets. Although informal feedback on the perceived value of the audit was encouraging, a formal review of all aspects of the audit was felt necessary. Methods: An independent formal review of VASM governance, documentation, datasets and data analysis was performed, in addition to a survey of 257 individuals (surgeons and other stakeholders) on the perceived impact of VASM. Results: The review confirmed increasing participation and acceptance by surgeons since the inception of the project. Governance mechanisms were found to be effective and acknowledged by stakeholders and collaborators. Robust participation rates have been achieved, and stakeholders were generally satisfied with the quality of feedback. Suggestions for improvement were provided by some surgeons and hospitals. Conclusion: External review of VASM processes and procedures confirmed that the audit was operating effectively, with robust quality control and achieving the trust of stakeholders. The educational value of the audit to the surgical community was acknowledged and areas for future improvement have been identified.

Clinical management issues vary by specialty in the Victorian Audit of Surgical Mortality: a retrospective observational study

“…The findings indicated that data collected through VASM could be translated into improvements in the quality and safety of patient care which had attained a robust and mature status. A concordance study confirmed that there was good agreement between first and second line assessors, as well as detecting a higher detection rate of clinical management issues by either assessor compared with the treating surgeon, thus validating the audit processes 18 19…”

Victorian Audit of Surgical Mortality is associated with improved clinical outcomes

“…It is also important to evaluate an activity such as VASM by an external ‘audit of the audit’, which was performed in 2011 by an independent consultancy company. This evaluation concluded that VASM processes were robust and mature after extensive consultation with stakeholders and independent scrutiny of data …”

“…This evaluation concluded that VASM processes were robust and mature after extensive consultation with stakeholders and independent scrutiny of data. 4 Attainment of 100% hospital participation has been an aim since inception and this was realized in 2012. Changes to CPD requirements by the RACS have also improved the participation rate of Fellows, as it is now compulsory.…”

National surgical mortality audit may be associated with reduced mortality after emergency admission

“…23 The Victorian Audit of Surgical Mortality prompted a third of its surgeons to implement changes. 24 The wider influence of audits (the Hawthorne effect) is well recognized. 25 The individual feedback in ANZASM is the fundamental difference from other audits.…”