But the government cites ‘identified cyber security risks’ and says auditing work will continue meanwhile.
As of late December, NSW surgery-related deaths could no longer be referred to the state’s long-standing independent review body, CHASM.
The Royal Australian College of Surgeons (RACS) lambasted the move, saying “it represents a serious step backwards for patients” and suggesting patient safety was being traded for “administrative convenience”.
But the NSW government body in charge of running the program said it had to be done, and auditing work would not stop in the meantime.
The NSW Collaborating Hospitals’ Audit of Surgical Mortality (CHASM) program reviews the deaths of patients who die within 30 days of having surgery or being under the care of a surgeon (even if an operation is not performed) during their hospital stay. It is an independent, peer review education program led by surgeons.
The previous model had been around for 20 years, and new technologies and data sets were now available, a spokesperson from the Clinical Excellence Commission, which manages the program, told HSD.
“The new model will provide the foundation for CHASM’s ongoing work,” they said.
“Central to the new model is the need to comply with NSW Government cyber security standards and address emerging cybersecurity risks identified within the previous framework. These cybersecurity threats had been discussed with partner agencies, including the Royal Australasian College of Surgeons.
“To support this improvement work, the [CHASM] Committee will be working with the Clinical Excellence Commission (CEC), NSW Health and key surgical representatives over the next 6 months to reshape and strengthen surgical morbidity, mortality and incident reviews in NSW.”
CHASM’s replacement is expected to be in place by mid-2026.
It “will feature enhanced data analysis, ongoing peer review, multiple data sources and strengthened data security and patient privacy measures,” the CEC spokesperson said. It would also be led by the CEC.
The college said the change was a big one and the decision should have been a ministerial one.
“As a ministerial body operating within government, any decision to dismantle, suspend or materially weaken CHASM is a matter of ministerial responsibility and cannot be characterised as an administrative or operational adjustment,” the RACS said in a statement yesterday.
It said the six-month gap “creates a foreseeable and avoidable risk to surgical patients in NSW and is inconsistent with the standards of transparency and accountability expected of a modern health system”.
Internal hospital audits were not an equivalent substitution, said the RACS.
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“Reporting deaths … is not the same as auditing them. Without independent, structured peer review, data risks becoming a passive record rather than an active tool for prevention. Independent audits routinely identify delays in diagnosis, transfer or intervention that may not be apparent to teams reviewing their own cases,” it said.
However, the CEC told HSD that “[d]uring the transition the CHASM committee will continue its work under section 20 of the Health Administration Act 1982. It remains empowered with special privileges under section 23 of the same Act.”
Along with similar entities in the other states and territories, CHASM feeds information into The Australian and New Zealand Audit of Surgical Mortality (ANZASM), which systematically collects data on every surgical death around the country and provides nationwide information about the leading causes of death, identifies system or process errors, trends in patient care deficiencies, and helps to develop ways to reduce the amount of surgery-related deaths. It is overseen by RACS.
CHASM is a member of ANZASM, but it’s a little different to the entities in other states in that they’re managed by RACS, while it’s managed by the NSW government’s Clinical Excellence Commission, using RACS infrastructure, with, according to the CEC hierarchal structure chart, the NSW Minister for Health in charge. Also, all public and private hospitals in jurisdictions other than NSW participate in ANZASM.
The RACS requires its members to participate in the ANZASM if a patient dies, as part of their continuing professional development obligations.
In its most recent national report (2021-2022), it pointed out that ANZASM is “one of the few [clinical quality registries] that meets the requirements of the current [Australian Commission on Quality and Safety in Health Care] guidelines, with almost 100% participation, 100% capture and national reach in its activities”.
NSW’s withdrawal puts that at risk. And the RACS said it was not good for NSW.
“This model has demonstrably improved patient care across Australia and is widely regarded as a key contributor to Australia’s strong surgical outcomes by international comparison. NSW’s withdrawal does not enhance safety; it isolates the state from national learning,” the college said.
It costs NSW around $100,000 to participate in ANZASM, “a negligible investment for a high-impact safety function”, said RACS, “in the context of a multi-billion-dollar health system”. The consequences of not making that investment were much higher, it said.