Acute care 2021
Postoperative wound infections
The results of the 2019/2020 review period revealed that the positive trend in wound infection rates has been sustained since 2011. In the case of the vast majority of the surgical procedures investigated, infection rates have continued to decline or have remained constant. An upward trend is discernible in rectal surgery, while there are signs of a possible stabilisation in caesarean sections. For the first time, selected results were presented as an infographic.
Link to press release
Link to infographic
Due to the high burden COVID-19 has placed on hospitals and clinics, this review was suspended until the end of March. As the situation deteriorated towards the end of the reporting year, the review had to be suspended once again on 1 December. Due to the pandemic, Swissnoso and ANQ decided for the second consecutive time not to convene their symposium.
The measures decided on in the previous year to streamline and adapt the review method came into force on 1 October. The new digital tool significantly reduces the workload required of hospitals and clinics to undertake the follow-up survey. Now only one follow-up consultation is required following interventions with implants. There were also adjustments to elective interventions. Two online workshops were held to introduce the updated method.
Falls and pressure ulcers in adults
The pandemic had an impact on the prevalence review. It rapidly became apparent that caring for COVID-19 patients would place increasing demands on hospitals and clinics. Preparing and organising the review day is highly time-consuming and personnel-intensive, and for this reason the prevalence review on 9 November was cancelled to reduce the workload of the institutions.
In the reporting year, Bern University of Applied Sciences (BFH) conducted an in-depth analysis of the 2011–2018 review data. Two Master’s theses analysed the falls and pressure ulcer rate data as they related to structure and processes. The plan is to publish the results in an international journal.
At the beginning of October 2021, ANQ published the results of the analyses of the BFS data from 2019. In turn, the hospitals and clinics received specific additional evaluations. The overall rate of potentially avoidable readmissions was 4.7% in the case of all evaluable discharges. The predicted value was 4.5%. A total of 31 hospitals and clinics stood out.
Link to press release
Since its introduction, the SQLape method has been the subject of criticism. It proved impossible to significantly increase its acceptance, despite targeted measures and investments (e.g. in the SQLape monitor), so ANQ is now examining an alternative. Starting with the 2020 BFO data year, the Center for Medicare & Medicaid Services method (CMS method) will be used to review unplanned readmissions.
SIRIS Hip & Knee Implant Registry (SIRIS Hip & Knee)
In February, the two-year revision rates for primary hip and knee implantations were published transparently for individual hospitals/clinics for the first time. After approximately nine years of data collection, this marked an important milestone. The second transparent two-year revision rates were published on 7 December, thanks to the close cooperation of all those involved (the SIRIS Scientific Advisory Board (SSAB), the SIRIS Foundation, SwissRDL, swiss orthopaedics and the EG SIRIS Hip & Knee). Along with these, the 2021 SIRIS Annual Report and a summary of the report were published.
Link to the press release of 2 February 2021
Link to the press release of 7 December 2021
In autumn, the validation concept, comprehensively revised by SwissRDL, was adopted and posted on the ANQ web portal. This concept describes the measures that must be taken to ensure a high quality of data.
Link to the validation concept
SIRIS Spine Implant Registry (SIRIS Spine)
The EUROSPINE registry platform has been available to enter data into the SIRIS Spine implant registry since January. Since then, some 90 hospitals and clinics have been registering the specified spinal interventions.
The SIRIS Foundation Board and ANQ conducted a survey on the implant registry in June in conjunction with the registry operator EUROSPINE. The aim of this was to assess the user-friendliness of data entry, user support and the implementation status of registering data at hospitals and clinics. The responses were used to optimise the application and the process of registering data and to plan the next phases involved in expansion of the system.
In the second half of the year, preparatory work began for the next expansion phase in 2022. This will require mandatory recording of two further forms of spinal interventions.
Information on the registry and its expansion phases
Pilot project in acute outpatient care
The focus of the reporting year was on preparing for the hospital outpatient pilot reviews starting in the spring of 2022. In addition to designing them, work was carried out on awarding contracts, recruiting pilot institutions, determining indicators and variables, and specifying the survey processes. As part of the pilot project, nine hospitals and clinics will record clinical quality indicators, as well as PREMs and PROMs, for two interventions. The project aims to collect first insights into reviews in hospital outpatient settings and into long-term outcome assessment by patients. ANQ is working in cooperation with Heartbeat Medical Solutions GmbH on review logistics and with the Basel Academy on evaluation and reporting. An expert committee with representatives from the pilot hospitals and clinics will accompany the pilot phase and ensure reviews are being effectively implemented in everyday clinical practice.
Link to the pilot project
Quality Committees (QC)
QC Acute Care
In the reporting year, the task assignment of the QC Acute Care for 2021–2023 was updated and submitted to the ANQ board for approval. The committee met four times. Its main focus was on the tasks assignment of the EG SIRIS Hip & Knee, the validation concept for SIRIS Hip & Knee and a first draft of the evaluation concept for SIRIS Spine. The committee discussed evaluation of the reporting structure of the national comparison report for the Swissnoso wound infection review. After more than ten years, a change in methodology for the review of readmissions had been prepared. The committee were informed about the planned change in methodology and endorsed it. The QC also discussed a proposal of the SIRIS Foundation to implement a national registry for shoulder implants and submitted a recommendation for this to the board.
Two experts from French-speaking Switzerland were recruited to the committee, PD Dr. med. Timo Ecker of CHUV Lausanne and Dr. med. Julien Hämmerli of HUG Geneva, both distinguished clinicians that have been directly involved in preparing registries.
QC Prevalence Review
The 2021–2022 task assignment of the QC Prevalence Review was updated for submission to the ANQ board. The QC met three times; four meetings were originally planned. The experts in the QC focused on preparing for the review day on the 9th November, provided input on how training sessions should be conducted and were involved in the multi-year analysis of data from 2011 to 2018 on falls and pressure ulcers, thereby highlighting the findings for everyday clinical practice. The members intensively discussed the question of whether the review should be conducted in spite of the pandemic. One argument in favour of implementation was that hospitals and clinics were now dealing with COVID-19 patients as a matter of routine. An argument against implementation was the high burden currently facing hospitals and clinics and the fact that the review would have placed an additional heavy burden on the institutions. This argument ultimately tipped the scales in favour of cancelling the review.
Three of the four planned meetings were held. The main topic of the first meeting was how to transparently publish the results of the BFO data for 2019. In the second and third meeting, the QC SQLape primarily focused on the review method. The QC supported the change of method, and the expertise of its members contributed significantly to the decision to record unplanned hospital readmissions in the future using the CMS method. With a view to optimising the introduction of the adapted method, the QC requested the board to forgo transparent publication of the results of the 2020 BFS data year. This request was approved.
Expert Groups (EG)
The EG SIRIS Hip & Knee implant registry serves as a sounding board for the SIRIS Scientific Advisory Board (SSAB). In 2021, it met on four occasions. The primary issues that were discussed were data analysis and preparation and publication of the 2021 SIRIS Annual Report. The EG discussed and approved the summarised version of the annual report, the media release and the comprehensively revised validation concept.
For the first time, Prof. Moritz Tannast of Hôpital Fribourgeois (HFR) and Dr. Hermes Miozzari of HUG Geneva, two representatives of the swiss orthopaedics board, took seats on the EG. This simplifies and optimises transparency and the flow of information between the organisations.