Australasian Vascular Audit
Click here to go to the Audit webpage
Click here to learn how to use the AVA Application
Welcome to the Home Page of the Australasian Vascular Audit
History:
• The ANZSVS Bi-National audit is a directive from the executive of the ANZSVS with its inception and everyday administration being the responsibility of the Audit/CPD subcommittee of the ANZSVS. This subcommittee has a representative from each state as well as New Zealand.
• The concept of a bi-national audit had been on the Society’s agenda since at least early 2001. All ANZSVS executives and their respective Presidents have unanimously endorsed the concept since that time.
• At the business meeting of the ANZSVS members at the ASC in Christchurch in May 2007, an overwhelming majority of those present voted that the audit be progressed and in addition, without dissent, agreed that members should fund it.
• At the Vascular 2007 meeting later that year in Melbourne the membership at its AGM voted, again without dissent, that participation in the audit process as directed by the executive via the Audit/CPD subcommittee should be a prerequisite for ordinary membership. This however would require constitutional change.
• In the business meeting of the ANZSVS at the ASC in Hong Kong in May 2008, a motion that the proposed constitutional change be put as a democratic postal ballot to the full membership (as opposed to the other constitutionally legitimate method of a show of hands at the 2008 AGM) was passed. The democratic postal ballot was carried by a 92.4% vote.
• At the executive meeting of the ANZSVS at Vascular 2008 in Adelaide the executive directed the Audit/CPD to institute the audit in the format which had been sent to the membership in early May 2008. Executive Members Present: Peter Woodruff (Chair), Noel Atkinson (Secretary/Treasurer), Glen Benveniste, Bernard Bourke, Douglas Cavaye, Andrew Hill, Alan Scott, Jim May, Peter Subramaniam, John Crozier, Brendan Stanley, Philip Colman, John Golledge, Gary Fell, Michael Grigg, Robert Fitridge. At that meeting the nature of the audit embodied in the 4 attachments sent out to the membership (including the outlier mechanism) was ratified. This was then made clear at the AGM of the membership at that same meeting in September 2008.
• As of January 1, 2010 the ANZSVS Bi-National audit will be administered
- In Australia as the web-based Australasian Vascular Audit ( AVA)
- In New Zealand as a continuation of the current New Zealand National Vascular Audit
It should be noted that ANZSVS Associates who practise vascular surgery can apply to use the AVA application.
Key Features:
- The audit, in Australia, is protected by Commonwealth qualified legal privilege as a quality assurance activity (NZ has its own national legal privilege). Any divulgement of a participant’s identity is punishable by a substantial fine and a custodial sentence.
- The audit has been granted official RACS endorsement under its CPD programme.
- The audit is indemnified under the umbrella of the RACS insurance policy.
- The audit complies with current privacy legislation regarding the collection of health data in situations where it is not practicable to obtain patient consent and when the data is potentially de-identifiable. On the directive of the Privacy Commissioner this required RACS ethics approval which has been subsequently obtained.
- Participation in the audit is a necessary requirement for ordinary members to maintain membership of the ANZSVS.
- Membership of the ANZSVS is not related to performance.
- Scope of the audit; the audit will capture all vascular surgery performed in private and public practice but analysis of outcomes will be restricted to:
AORTIC SURGERY (Aneurysmal and occlusive disease):
- Survival rate during the same hospital admission:
- for open elective surgery
- for open surgery in patients thought to be actively bleeding or actively thrombosing at the time of intervention ( emergency intervention)
- for elective non-fenestrated EVAR
- for urgent non-fenestrated EVAR
- for fenestrated EVAR
CAROTID INTERVENTION (Endarterectomy and CAS):
- Major stroke free and death free rates during the same hospital admission post carotid endarterectomy
- Major stroke free and death free rates during the same hospital admission post carotid stent procedures
LOWER LIMB BYPASS SURGERY:
- Patency rate during same admission
- Ipsilateral limb salvage rate during same hospital admission
DIALYSIS ACCESS SURGERY:
- Primary Patency
• All members have been allocated a random number which also serves as the member’s username when opening the web-based audit. Given that trainees will know the consultant’s number they would be bound by legal privilege legislation to not divulge that number to any one else. The code would have to be broken in the case of outlying results requiring further evaluation and that would be only to the audit monitoring committee.
• For verification purposes, there will be a random audit process of a certain percentage of the membership. Those who are randomly audited will be expected to submit independent hospital collaboration of their previously submitted figures
Participants:
Participants are all current and future members of the ANZSVS. Participation in this activity recognises the algorithm for dealing with underperformers, and this algorithm provides natural justice for members and is fair and transparent. Click here to view the algorithm. Participants have agreed to abide by the outcome decided by the audit committee based upon the algorithm. All participants are identified by a random ID number known only to them and stored securely in the ANZSVS office. Protection of participants is ensured by the highest possible legislation (Commonwealth privilege has been granted to the ANZSVS audit as a quality assurance activity). Any divulgement of a participant’s identity is punishable by a substantial fine and a custodial sentence.
Plan and Design:
The audit will reside on a secure website administered by the successful tenderer (Boston Software). They are contractually bound to comply with privacy legislation pertaining to collection of health data, and will have the strictest level of industry-level website security currently available. Access to the database is restricted by the need for login by ID number and password. Ability to view data is restricted based upon security permission set by the database designer. Data will be captured by the web-based database and the following patient-identifying data will be entered; Patient name, Hospital and Hospital record number, Date of birth. The name and record number will be de-identified as soon as it is entered and stored in the database in the encrypted form. This is the issue that required ethics committee approval. Although this data will almost never be re-identified, in the event of an underperforming surgeon coming before the audit monitoring committee, the surgeon’s records and clinical circumstances of every patient will need to be examined. The re-identification of the patients is crucial so that the surgeon can obtain his/her own clinical records. Thus the capture of identifying data is crucial to the purpose of this audit process. The other reason that identifying data is crucial to the functioning of the database is the fact that if a patient is re-admitted and data entered for this patient at a later date, then this fact needs to be identified so that duplicate data is not entered. The patient name, hospital, hospital record number and patient DOB will be used as the unique identifying combination, which would then prevent demographic and risk factor data from being re-entered. It needs to be emphasised that all possible measures are being undertaken to protect patient privacy.
The database captures information relevant to all vascular operations and queries have been designed to extract data for statistical analysis. This results in a process of risk adjustment, so that high-risk patients are identified. Outliers are then identified by analysing risk-adjusted outcomes by means of CUSUM analysis as well as funnel plots for comparison of data between surgeons and institutions. The identity of the surgeon is only revealed from the randomly allocated ID number once an outlier is identified. It is crucial to understand that the statistical tests only identify possible underperforming surgeons….the main method of audit lies with the audit monitoring committee, an elected 3-5 experienced practising vascular surgeons. It is only after careful and mature examination of each of the clinical circumstances, that remediable action would be considered.
Participation in this activity will be used as proof of audit by the RACS for recertification and CPD purposes and it has been given the status of “approved audit for the purpose of CPD” by the RACS CPD department. The results of de-identified data will be used for publication both internationally and nationally. The database will allow participants to compare results of their own outcomes against the national pooled data.
Date of Commencement:
The database will begin live data capture from 01 January 2010. This AVA application will have been intensively tested over the 6 months prior to this date, during the design phase
Chair ANZSVS Audit/CPD committee
November 2009
