[Quality assurance with hospital routine data in general and visceral surgery: colon and hernia surgery]

Routine data not only allow for the mapping of a department in terms of quality-relevant aspects, but also for a comparison with other hospitals in the context of hospital associations. Currently available system options are demonstrated using the example of a department for general and visceral surgery.

Quality indicators and their algorithms have been developed by the CLINOTEL office in consultation with specialist disciplines. The base population as well as the specific criterion that stands for the unwanted event to be investigated is defined for all individual quality indicators by way of in- and exclusion criteria. In addition, case reports are transmitted; these are lists of relevant case data, which are prepared as soon as at least one quality indicator has been identified from the analysis of the case data (screening function).

A total of 16 case reports were generated for 251 cases of hernia, which corresponds to 6.4%. There were 21 case reports for 58 colon resections (36.2%). 5 cases of hernia and 11 cases from the group of colon resections were presented in M&M conferences, in the course of which measures to prevent unwanted events during colon and hernia surgery were developed. A part of these measures was also the introduction of a "for immediate medical attention" checklist, containing a list of clinical symptoms that in our view require the immediate attention of a doctor. Previously, our M&M conference had no defined "script" that would include questions in need of urgent attention and therefore of urgent answers. However, the complexity of individual cases has shown that the conferences must acquire a more formalised format.

QSR constitutes an important information channel with a positive cost-benefit ratio for department managers of surgical clinics. The information gained can be used for clinical quality monitoring and also for the screening of conspicuous courses of treatment. Taking into account the intrinsic limitations of classification systems for diagnoses and procedures, and a systematic monitoring of documentation and coding quality, this should result in a continuous improvement process in terms of surgical care.