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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
ADS AMDS
1996 1999 2014 GV
A-QUACH
2016
ADS
laun
ch
SGAR
/SSA
R su
ppor
t
2007
AMD
S la
unch
2015
KDQ
, Pro
tec
AG
A-Q
UA la
unch
ADS
end
2011 GV
Proj
ect i
nitia
tion
Proj
ect
2015
2017
Part
A
WBS
man
dato
ry
2020
Part
B
WBS
man
dato
ry
today
2012
Revi
sed
prog
ram
war
rant
ed
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
Opt
ions
to c
hoos
e
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 @ [email protected]
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 (degression)
Anschubfinanzierung durch SGAR bis jährlich 300’000 Datensätze eingehen Abteilungen bezahlen MAX. 31 RAPPEN pro Datensatz
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 [email protected]
