How to facilitate supervision? How to improve quality? How to improve transparency? Dutch hospitals

1996“KWALITEITSWET” (Act on Quality) »Legislation with quality guarantees within institutions for health care. »Description of quality systems is no guaranty for outcome in complex organisations »High expectations, poor results

Patientsafety Reducing Medical Errors requires National Computerized Information Systems; Data Standards Are Crucial to Improving Patient Safety

Supervision Quality Tranparency

Gefaseerd toezicht LOW RISK Fase 2: TESTING TEST AT RANDOM QUALITY ASPECTS HOSPITALS FINISH OR TESTING HIGH RISK Fase 1: COLLECTING INFORMATION MINIMAL SET INDICATORS Risico- analyse RISK ANALYSIS EXTERNAL DATA RESOURCES RISK MODEL Fase 3: INTERVENTION

Death Disease Discomfort Disability Dissatisfaction

Proces  Indicators Structure / Organisation  Indicators Outcome Indicators Patient

An Indicator: Signal function consequences only after inspection

Outcome indicator Signal function no representation Consequences only after specific research Maturity model Interpretation by the hospital itself Efficiency profit for hospitals as well as IGZ Public presentation on www hospital

Selection criteria Feasibility Focus on hospital care Clinical relevance Frequent manifestation Obvious and rapid improvement of quality outcome

Procedure Indicator acquisition by –Literature search –Stakeholders interviews –Expert interviews –Expert meetings –Scientific board meetings

Categories Set reflecting the outcome of the hospital in general (bedsores, medication etc) Set reflecting the outcome of high risk departments as ICU, Surgery and Emergency Set reflecting specific categories of diseases as diabetes, cardiac failure etc.

Hospital-wide IndicatorStructureProcessOutcome 1. Pressure Ulcer1.1Registration of Pressure Ulcer prevalence/incidence 1.Point prevalence pressure ulcers I.2 S Incidence of pressure ulcers by patients with an indication for total hip replacement 2. Blood Transfusion2.1 Presences transfusion reactions registration 2.2 S Transfusion Reactions 3. Medication Safety1.Availability inpatient and outpatient medication overview 2.Availability regional medication overview 4. Information Technology1.Availability of electronic data in the outpatient consultation rooms and on the hospital wards 2.Availability of process- supporting IT in the outpatient consultation rooms and on the hospital wards 3.Free access to Internet and internal and external for care professionals 5. Wound Infections5.1Wound infection registration 6. Complication registration6.1Complication registration per specialty/discipline 6. Risk Inventory7.1Availability of clinical risk inventory

The emergency ward, operation theatre and intensive care units IndicatorStructureProcessOutcome 1. Post-operative pain1.1 Percentage of post-operative patients having received standardized pain measurements 1.2SPercentage of patients whose pain score is less than 4 within the first 72 hours 2. Volume of high risk interventions 1.Volume of acute aneurysm of the abdominal aorta surgery 2.Volume of esophageal resections for esophageal carcinoma 3. Laparoscopic surgery3.1aSRatio of laparoscopic versus open cholecystectomy 3.1bSRatio of laparoscopic cholecystectomy in day care versus inpatient laparoscopic cholecystectomy 3.2SPercentage of conversions from laparoscopic to open cholecystectomy 4. Cancelled operations4.1Number of elective operations cancelled within 24 hours before surgery 5.Unplanned re- operations 5.1aPercentage of unplanned re-operations 5.1bTop three unplanned re-operation indications 6.Intensive Care hour availability of a registered intensivist 6.2Mean and median of number of artificial respiration days per patient requiring artificial respiration

Condition- or intervention-specific indicators IndicatorStructureProcessOutcome 1. Pregnancy1.Percentage of cesarean sections 1.2SPercentage of vaginal deliveries after cesarean section 2. Diabetes2.1Presence of Integrated Diabetes Care service 1.Mean HbA1C value 2.Percentage of patients receiving an eye examination every two years 3.Heart failure3.1Presence of Outpatient Heart Failure Clinic 3.2Readmission rate for heart failure patients 4. Acute myocard infarct4.1 In- hospital mortality 4.2S 30 days mortality 5.Cerebrovascular accident 5.1Presence of Stroke- service / hospital stroke unit 5.1 In- hospital mortality 5.2S 30 days mortality 6.Hip fracture6.1Percentage of patients operated within 24 hours after admission 7.Total hip replacement7.1Presence of Joint Care service 8.Mamma tumor8.1Presence of Outpatient Mamma Care Clinic 8.2Percentage of patients receiving diagnosis within five days of first outpatient visit 9.Cataract surgery1.Presence of cataract surgery unit and care pathway 2.Presence of cataract surgery complication registry 9.3aCorrected post-operative vision 9.3bMean difference between the actual and the intended refraction after cataract surgery 10.Refraction surgery10.1Reduction in refraction

Time table January 1. Hospitals received the set. June 1. Deadline for hospitals July 1. All hospitals had responded; Autumn 2004; Analysis of data February; Publication set 2004 May 2005: General report 2003 June 2005; Publication set 2005 July 1. Deadline for hospitals September; Publication set 2006

Electronic medication information available in the clinic Electronic medication information available in the out-patient clinic

Pain measurement in a standard way Pain measurement

Post surgical pain

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