[Aspects of external quality assurance in anesthesiology--experiences in Hamburg]

In 1994, external quality assurance in anaesthesia according to the German Society of Anaesthesiology and Intensive Care (DGAI) was obligatory introduced in Hamburg. Since 1992 in a pilot project and since 1994 compulsory nearly 500,000 anaesthesias were documented by 39 institutions with a standard data set issued by the DGAI and transferred to the project office of the Association for Quality Assurance (EQS) Hamburg. Comparative statistics of these data were produced at the project office. In the controlling committee and in meetings of the project participants the contents, policy and results of the project were critically analyzed and adjustments initiated whenever necessary. With an incidence of 14.1% of all anaesthesias with special occurrences (AVB), the results are in the same range compared to most other studies. To evaluate the concept of documentation the predictory power of single and combined risk assessments for the incidence of particular AVBs in elective anaesthesias were compared to the predictory power of ASA-Classification in order to reduce the parameters that had to be collected. This should lead to a positive influence on the quality of documentation. Besides one exception, no superior prediction power for AVB incidence could be demonstrated for any special risk assessment as compared with the ASA-classification. This is also true for the AVBs which are associated with high lethality. Thus, the documentation of risk factors in the core data set as predictors can be abandoned without major loss of information. The participants consider the project to be a useful support for internal improvement projects. Besides the reduction of the amount of data in quality assurance to get a core of particularly meaningful parameters the classification of the surgical procedure by the ICPM- or OPS 301-Code should be integrated into the core data set of the DGAI. It would lead to an increase in acceptance of the method and thus to an increase in the validity of its results and valuations.