Assessment of accuracy of Australian health service death data: implications for the audits of surgical mortality

McCahy, Philip; Tayyaba, Iqra; Andrew, Madison S; Lim, Cheryl; Pornkul, Panuwat; Lay, Joshua; Chin, Calvin W.; Nguyen, Phi; Vinluan, Jessele

doi:10.1111/ans.15827

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Administrative data are notoriously inaccurate and a reason for the extensive development of CQR's overseas. An Australian example is the significant discrepancy between the greater number of mortalities reported to the Victorian Audit of Surgical Mortality and the numbers in administrative data held by the Victoria Admitted Episode Dataset [33].…”

Section: Discussionmentioning

confidence: 99%

Observations from Australia's National Surgical Mortality Audit

Hansen,

Itotoh,

Helena

et al. 2023

World j. surg.

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Background Australia is the only country with a national surgical mortality audit. Every Australian surgical mortality is independently and externally reviewed by another surgeon. Extensive educational feedback to surgeons and hospitals is provided through individual patient reviews, state and national symposia and reports, and the distribution of deidentified informative cases. This study reports a longitudinal analysis of the Australian surgical morality audit. Methods The standardised mortality ratio (SMR) was calculated for each state and territory, nine surgical specialties and nationally. The index year used was 2016, or every 5 years for those states with earlier data. Overall data were analysed in three groups-all deaths, postoperative deaths and non-operative deaths. Overall specialty data were analysed nationally. Results There was a consistent progressive fall, usually in excess of 20%, in the SMR in each state and territory and by specialty when compared to the index year. This was statistically significant nationally (p = 0.044). The same change was observed in earlier years in states with longer-term data. ConclusionThe period of this observational study has been associated with a nationwide fall in surgical mortality. As other improvements in care will have occurred during this period, the contribution that Australia's national mortality audit made towards the lower surgical mortality cannot be stated with certainty.

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Section: Discussionmentioning

confidence: 99%

Observations from Australia's National Surgical Mortality Audit

Hansen,

Itotoh,

Helena

et al. 2023

World j. surg.

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“…The Victorian Audit of Surgical Mortality (VASM) is part of the Australian and New Zealand Audit of Surgical Morality (ANZASM) which, over the past decade, monitors and reports on patient management issues related to surgical mortality. 1,2 As with all datasets the accuracy of the VASM data, and the lessons that can be drawn from it, depends on the integrity of the source information. We have previously reported incomplete data submission to VASM by a large Victorian health service.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of potential clinical management issues in unreported mortality data from an Australian health service

Qin

Vinluan

McCahy

2023

ANZ Journal of Surgery

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Background:We have previously reported incomplete data submission to the Victorian Audit of Surgical Mortality (VASM) by a large health service. We have further examined the source health service clinical data to assess whether any clinical management issues (CMI) occurred and should have been reported. Methods: The previous study identified 46 deaths that should have been reported to VASM. The hospital records of these patients were further analysed. Data recorded included the patient's age, gender, admission type and clinical course. Any potential clinical management issues were recorded and classified using the VASM definitions (area of consideration or concern, adverse event). Results: Median age of the deceased patients was 72 (range 17-94), with 17 (37%) being female. Patients were under the care of nine different specialties with general surgery being the most common (18/46). Only four (8.7%) of the cases were electively admitted. 17 (37%) patients had at least one CMI with 10 (21.7%) classified as adverse events. Most deaths were not considered preventable. Conclusion:The proportion of CMI in the unreported deaths was consistent with the previously reported VASM data, however current findings show a high percentage of adverse events. The underreporting may be due to inexperienced medical staff or coders, poor quality notes or confusion about what should be reported. These findings reinforce the importance of data collection and reporting at the health service level, and a number of important lessons and opportunities to improve patient safety have been lost.

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Accuracy of surgical death information: comparison of data held by Victorian Audit of Surgical Mortality and Victorian Agency for Health Information

McCahy,

Kattini,

Tan

et al. 2024

ANZ Journal of Surgery

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BackgroundThe Victorian Audit of Surgical Mortality (VASM) investigates all surgically related deaths in Victoria. The Victorian Admitted Episodes Database (VAED) is an administrative dataset maintained by the Health Department's Victorian Agency of Health Information (VAHI). We have reviewed clinical records to assess the correlation between deaths reported to the databases.MethodsData July 2019 to June 2020 were compared. All hospitals that had surgical deaths not reported to VASM were asked to provide clinical summaries which were analysed to assess the deaths should have been reported. Case note review of 280 deaths only reported to VAHI through VAED was undertaken to establish whether these should have been reported to VASM.ResultsVASM received 1763 reported surgical deaths with VAHI recording 1907. Using individual patient identifiers, 517 (29.3%) of the VASM deaths were not reported to VAHI but subsequent data analysis revealed they were correctly identified as reportable deaths in 385 (74.5%). There were 914 (47.9%) VAED recorded deaths that were not reported to VASM. 280/914 (30.6%) were reviewed from 21 hospitals. Only 24 (8.6%) of these had a surgical procedure in the patient's final admission and should have been reported. This suggests that the current method of VASM capture of surgical mortality only missed 4% cases for the 2019/20 year.ConclusionThere were major differences between surgical deaths reported to VASM and those reported by health services and recorded in VAED. Less than 5% of cases are not reported to VASM and thus not subjected to peer review.

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Assessment of accuracy of Australian health service death data: implications for the audits of surgical mortality

Cited by 3 publications

References 6 publications

Observations from Australia's National Surgical Mortality Audit

Observations from Australia's National Surgical Mortality Audit

Analysis of potential clinical management issues in unreported mortality data from an Australian health service

Accuracy of surgical death information: comparison of data held by Victorian Audit of Surgical Mortality and Victorian Agency for Health Information

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