National indicators
Assessing the quality of a hospital's services is not easy. To achieve objective measurements, the Federal Office of Public Health (FOPH) and the National Association for Quality Development in Hospitals and Clinics (ANQ) have developed a series of indicators covering acute care, rehabilitation and psychiatry.
Acute care currently has the most positive indicators, notably in terms of:
- mortality rate for pathologies and/or procedures
- monitoring of surgical site infections
- potentially preventable reoperations and readmissions
- prevalence of falls and pressure sores
- patient satisfaction.
Each year, the FOPH publishes the report "Quality Indicators of Swiss Acute Care Hospitals". This report outlines the mortality rate for 55 pathologies and procedures as well as the number of patients treated. It also gives the percentage of activity for certain pathologies or procedures (for example the percentage of births by cesarean section).
The HUG's results are available on the FOPH website. Explanatory comments may be added by the hospital when the results of the indicator fall below expectations.
Monitoring of surgical site infections
In 2016-2017, Geneva University Hospitals were involved in monitoring surgical site infections for the colon, rectum and heart, as well as for laminectomy-type neurosurgery, with or without implants. The results reveal infection rates in line with expected standards.
Potentially preventable readmissions and reoperations
The HUG takes special care to avoid patient readmissions and reoperations wherever possible. In some cases, such follow-ups are inevitable, but nevertheless offer an interesting indicator of quality. As such, close monitoring is carried out with the aim of always exceeding the norm.
Readmission is considered potentially preventable if the following three conditions are met:
- it was not planned at the time of discharge from the previous hospitalization
- it is caused by at least one affliction already known at the time of this discharge
- it occurs within 30 days of discharge.
Readmissions at another hospital are also taken into account. Their causes are not always easily identifiable. The literature indicates that around 25% of these readmissions are connected with the hospital, about half with the outpatient sector and about 25% are a result of the condition's development despite adequate care.
A reoperation is considered potentially preventable if it could not be predicted at the time of the operation preceding it, and if it relates to the same operating site or reflects an operative complication. Only reoperations that take place during the same stay are taken into account.
The latest results published by the ANQ (2015 data) show an observed rate for both readmissions and reoperations below the norm (see the graph below).
Generally speaking, these indicators are not designed to rank hospitals in order of success. They simply allow each hospital to have a kind of "gold standard" in the context of the patient population it cares for, in order to identify any potential measures for improving treatment and care.
Constant monitoring for a quick response
The results of the national indicators are communicated to hospitals up to two years after the fact. Because of the risk of a slow response as a result of this delay, in early 2018, the HUG introduced regular measurements of certain indicators (potentially preventable reoperations and readmissions, falls, pressure ulcers). The aim is for clinical services to be informed and alerted as quickly as possible should any problems arise.