Program A-QUACH Quo vadis Improving Anesthesia QUAlity in Switzerland

Generalversammlung - 10.11.17

Prof. Dr. med. Michael Ganter

SGAR/SSAR Annual Meeting 09 –11. November 2017, Interlaken

Ausführliche Informationen im Bulletin Nr. 33, Juni 2017 Weiterentwicklung: Eingabe, Schnittstelle, Reporting Perioperative Prozesszeiten (V2 2017, Mini-Update)

– Absprache mit Schweizerische Fachgesellschaft für OP-Management

– H+/REKOLE: REK 14_006 A-QUA Codierung

– Anpassungen (Anästhesien ohne Eingriff, Codes 50xx), Wegleitung

Dringlichkeit des Eingriffs – Kategorien angepasst und klar definiert, Wegleitung

Aktivitäten rund um A-QUACH

Jährliche Datenerhebung durch Abteilungsleiter Validierung durch KDQ SGAR, Freigabe im Q4

des Folgejahres Verpflichtend für SIWF WBS seit 2016 Aktuell (2016): 90 Abteilungen nehmen teil

(diese leisten jährlich 697’870 Anästhesien) Reports: Strukturiert, Benchmark, XLS

Teil A: Strukturdaten

Kontinuierliche Datenerhebung Import zu A-QUA, Validierung, Freigabe Verpflichtend für SIWF WBS ab 1.1.2020

(SOLL) bzw. 1.1.2022 (MUSS), gem. GV 2016 Aktuell: Schnittstelle für Import funktioniert,

erste Abteilungen nehmen teil Reports: Strukturiert, Benchmark (später), XLS

Teil B: Patientenbezogene Daten

Weitere Informationen

http://www.sgar-ssar.ch https://www.healthbase.ch/aqua/ -> Ausstellung

Program A-QUACH Quo vadis Improving Anesthesia QUAlity in Switzerland

Refresher Course III - 9.11.17

Prof. Dr. med. Michael Ganter

SGAR/SSAR Annual Meeting 09 –11. November 2017, Interlaken

Why A-QUACH ? Improving Anesthesia QUAlity in Switzerland

... to measure is to know – if you cannot measure it, you cannot improve it ...

Lord Kelvin (William Thomson)

1824-1907

None Board member SGAR/SSAR and president of the committee for data & quality in anesthesia (KDQ)

Kantonsspital Winterthur uses the following electronic health record (as customer) PDMS: HIM Q-CARE / A-UI

Health Information Management

Conflict of interests

How to improve quality – SGAR/SSAR and quality

A-QUA Part A – Data from institution – Reports, current participation

A-QUA Part B – Data from individual cases – Module 2a,b (activities) – Modules 3 (pre-op), 4 & 5 (intra-/post-op events) – Data management – upload, interface, security

Further information on A-QUA

Agenda

How to improve quality ? Health provider

Individual Environment (workplace) Organization

Training, CME – knowledge, technical, non-technical skills ... Compliance with current standards Accreditation Certification

Examples:

How to improve quality ? Patient care Standard of care, data monitoring/recording, risk management Health record, routine data – (e-)HR: KIS/PDMS ... Additional data – surveys, data for BAG, ANQ, AQC, registries ... CIRS & adverse event management Billing data

A-QUA – standardized data collection and reporting: institution and case-based incl. benchmark Outcomes – patient satisfaction, national morbidity / mortality rates incl. benchmark Error-Risk Management – collection, analysis (ERA, RCA) and reporting (M&M) of near misses, unusual cases, adverse events, and serious patient injuries ... Costs – ranking (standard DRG...)

Examples:

SGAR/SSAR AND QUALITY Commitees – Foundations – Task forces

K committee (Kommission) St foundation (Stiftung) AG task force (Arbeitsgruppe)

Quality section SGAR/SSAR

http://www.sgar-ssar.ch/die-sgar/uebersicht/

ADS / A-QUACH program

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A-QUACH is mandatory

A-QUA IS MANDATORY Part A – since 2016 Part B – transitional period 1.1.2020 (1.1.2022)

QM – part of the SGAR/SSAR-specific quality program, fulfilling criteria of the legal basis for quality assurance (Art. 58 KVG, Art. 77 KVV) Mapping – Swiss anesthesia development

over time on different levels Politics / health insurances etc. – basis and

tool for negotiations Research – database for longitudinal studies,

clarification of specific, scientific questions

A-QUACH – goals

http://www.sgar-ssar.ch/ - KDQ, A-QUA

A-QUACH – summary

Part A. Data from institution

«module 1» 1. Institution

– setting and structure – summary of activities – staff requirements

Part B. Data from individual cases

«module 2-5» 2. Activities

– discipline, urgency – intervention (A-QUA Code) – time stamps, location – type of anesthesia, monitoring

3. Pre-op risk 4. Intra-op events 5. Post-op events

PART A – A-QUACH Data from institution

Annual data entry (head of department), Q1 KDQ validation, clearance Free of charge 2016: 90 institutions (697’870 anesthesia) Reports: Structured, Benchmark, XLS

Part A: institution

http://www.sgar-ssar.ch/ - KDQ, A-QUA and https://www.healthbase.ch/aqua/

Entered data report, example

Department xxx

Department xxx

...

Benchmarking

https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark

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ions

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Benchmark report, example

all training centers (WBS) do ~500,000 anesthesia cases

Department xxx

https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark

...

https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark

https://www.healthbase.ch/aqua/ - Report: Abteilung im Benchmark

Detailed and structured report: numbers and graphs B Benchmark: Median (Minimum / Maximum)

CURRENT PARTICIPATION A-QUA Part A

Part A – institutions

78% !!

Part A – institutions

A-QUA Strukturdaten

PART B – A-QUACH Data from individual cases

Continuous data acquisition (local/online) Import into A-QUA, validation, clearance Mandatory for SIWF WBS after 2020 (2022) Current: A-QUA ready, few departments Reports: Structured, Benchmark, XLS

Part B: individual cases

http://www.sgar-ssar.ch/ - KDQ, A-QUA and https://www.healthbase.ch/aqua/

Activities Anesthesias (module 2a)

201xx Case identification (PID, FID, LNR, BD, SEX)

202xx In-/outpatient; Urgency

203xx Specialty

204xx Type of procedure (A-QUA Code)

205xx Location (procedure, post-anesthesia unit)

206xx Time stamps

207xx Type of anesthesia, anesthesia techniques

208xx Monitoring, additional techniques

Services (module 2b) 201xx Case identification (PID, FID, LNR, BD, SEX)

209xx Services

210xx Time stamps

Classification of urgency

Elective case, no urgency

• Interventions that can be scheduled ahead

Emergency 6-24h, not threatened vital (deferred urgent intervention )

• Non-vital emergency, requiring care within 24 hours

Emergency 1-6h, not threatened vital (urgent intervention )

• Non-vital emergency, but requires urgent care within 6 hours

Emergency <1h, threatened vital (immediate intervention necessary )

• Vital emergency requiring immediate care

Procedures Main procedure (1)

Secondary procedures (3) to be coded by A-QUA Codes (n=165)

– Procedure groups – Well defined, standard

interventions

http://www.sgar-ssar.ch/ - KDQ, A-QUA Codes

A-QUA Codes

Working principle Chapters (ex TARMED)

e.g. 06

Procedure group (Name) e.g. Code 0602: Diskushernien OP LWS, eine Etage (Standardeingriff) – Well defined, standard

intervention – Definition of procedure(s)

LWS Dekompression ein- oder beidseitig bei Discushernie, eine Etage, alleiniger Eingriff

– Key words Discushernie, Fenestration, Hemilaminektomie, Laminotomie

– Surgical risk class = 3

Time stamps (A1-A12)

2014 (Version 1) first published by SGAR / SSAR

2017 (Version 2) minimal adjustments due to revision of the «Deutsches Glossar perioperativer Prozesszeiten und Kennzahlen» (BDA/DGAI, BDC/DGCH, VOPM) available D, F, I

Association of Swiss hospitals has adopted these definitions (REK 14_006)

Time stamps (A1-A12) mandatory for A-QUA, REKOLE A = für A-QUA verpflichtend Anästhesie Betreuungszeit (A1-A12), Ein-Ausleitung (A2-A10), Schnitt-Naht (A7-A8)

R = für REKOLE® verpflichtend (REK® Entscheid 14_006) Empfehlungen der SGAR/SSAR bezüglich Interpretation der REKOLE Zeiten: • Anästhesie Betreuungszeit (Anästhesie Leistungszeit im OP Saal, AnLZ)

Beginn Anästhesiebetreuung (A1) bis Ende Anästhesiebetreuung (A12) • OP Saal-Zeit

Beginn op. Vorbereitung (nicht-ärztlich, Lagerung; A4) bis Saalausfahrt (A11) • Ärztlich chirurgische Leistungszeit (chLZ)

Beginn op. Vorbereitung (ärztlich, Desinfektion; A6) bis Ende op. Nachbereitung (A9)

Pre-op risk A-QUA module 3

Intra-op events (1) A-QUA module 4

Intra-op events (2) A-QUA module 4

Post-op events, 24h (1) A-QUA module 5

Post-op events, 24h (2) A-QUA module 5

DATA DELIVERY PART B Upload / online, de-personalisation of patient data

Upload formate: XML

(Extensible Markup Language): file-upload or webservice

Interface specifications to

be ordered @ a-qua@healthbase.ch

Local data storage / upload interface

XML file – example

Online data delivery

https://www.healthbase.ch/aqua/portal/portalAqua/index.php

etc. etc.

Online data delivery

m2

m4

m3 m5

Contract, data protection

+

http://www.sgar-ssar.ch/ - KDQ, A-QUA - Dokumente

ID: secret, reproducible code

Data check

Ø FID, PID,BD,

LNR

De-personalisation, database

http://www.sgar-ssar.ch/ - KDQ, A-QUA - Dokumente

Part B – costs

Kostenbeteiligung SGAR bis jährlich 200’000 Daten (bis 20’000 CHF) Abteilungen bezahlen MAX. 31 RAPPEN pro Datensatz (-.21 + -.10 CHF)

Bsp. 10’000 Anästhesien jährliche Kosten max. 3’100 CHF Slide from General Assembly SGAR/SSAR November 2016

FURTHER INFORMATIONS Program A-QUA

Further informationen

-> Exhibition

Q-CARE AUI

ISMED EOPPS

A-Q

UACH

eHR

& A

-QUA

CH

-> Exhibition

Further informationen

http://www.sgar-ssar.ch https://www.healthbase.ch/aqua/

... groups that understand their own performance are best positioned to improve it,

and can use this understanding to win and maintain their service contracts ...

Richard P. Dutton, MD MBA Oxford University Press 2016

Why measuring data ?

Measure and monitor your data !!!

Program A-QUA is ready The dataset and each variable is well defined Meaningful benchmarking becomes available

Why A-QUACH ? Improving Anesthesia QUAlity in Switzerland

Thank you

Prof. Dr. med. Michael Ganter Institute of Anesthesiology Kantonsspital Winterthur michael.ganter@ksw.ch