gms | German Medical Science

Introduction: There are several defined treatment processes in surgical clinics, often called pathways, with set decision algorithms. These are based on current guidelines and surgical experience. Goal criteria are generally high surgical outcome and process quality. Goal criteria can be monitored by surveillance of key parameters.

Referring physicians sometimes judge outcome and process quality of a surgical clinic from a different perspective. From this point the individual case is much more emphasized and sometimes even outcome quality is defined in a different way.

Material and methods: We demonstrate how different assessment of outcome quality can be by the example of long term dialysis catheters and how to establish a benchmarking system of referring physicians by using an internal documentation. This allows for a structured analysis together with the referring physicians illustrating differences in assessment criteria and setting up joint target agreements.

Results: From January 2006 until December 2012 we performed a total of 4.955 dialysis access procedures. From these 1.020 (20,6%) were implantation of tunneld long term catheters. Average dwell time was 159 days, 45% were removed electively after successful creation of a permanent vascular access. 15% of patients died with running catheter, 12% of catheters are still in use. Goal criteria in some dialysis centers include reduction of catheter use as vascular access for hemodialysis to less than 20%. In joint case conferences we could illustrate differences in patient population and morbidity for some dialysis centers. A concept of reducing catheter use was developed by setting up individual access plans for all center catheter patients. By realization of this concept catheter use was reduced by 50% in one dialysis center.

Conclusion: Process and outcome quality are sometimes defined in different ways in different sectors of the health system. Close communication and cooperation of hospitals and referring physicians may illustrate differences in assessment criteria and lead to joint target agreements. For this internal documentation and evaluation of all necessary key parameters are essential.