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[Systematic scientific quality improvement in surgical specialties. The AQS mode]
1Frauenklinik, Spital Limmattal, Schlieren.
Background:
How can the new legal requirements (Law on Statistics 1992 with its corresponding regulations of 1993: minimum data record of the Federal Department of Statistics (BFS) with ICD codification and the law on medical insurance 1995 with its corresponding regulations of 1996: necessity of documenting quality and efficiency) be integrated into the daily hospital routine with reasonable expenditure of time and costs?
Method:
The BFS minimum data record was combined with additional information on quality improvement on one single questionnaire. The surgical departments of the Hospital Limmattal in Schlieren and the Regional Hospital Bienne founded the Association for Quality Improvement in Surgery (AQC) in 1995 and have tested the AQC system for two years.
Results:
Until the end of 1997 data from 15,115 surgical procedures were collected in our database. In addition to the more time consuming collection of the "minimal data set of the Federal Department of Statistics (BFS)" which requires between 3 to 10 minutes, the collection of the additional AQC-data will take 1 to 3 minutes.
Discussion:
There is an increasing expenditure of time and costs as a result of legal requirements. Expenditure may, however, be kept within manageable limits if a single questionnaire serves several purposes simultaneously. The AQC system does not only meet the legal requirements as to systematic quality improvement and BFS statistics, but can also be used for the annual statistics of the clinic, the statistics of individual surgeons, and for hospital comparisons provided other clinics adopt the system as well. There are no standards, reference areas or indicators as yet, but such tools may now be developed much more easily with comprehensive data available through the AQC system.
Conclusions:
The AQC system has proved to be a manageable tool in the hospital routine; it could thus be implemented as a wide-area system to provide systematic quality improvement and to meet other statistical requirements.
