Indicators

Introduction

In the health services in 2016 quality and transparency are important subjects. This can be drawn from the development of guidelines for medical procedures and indicators in order to be able to measure the effectiveness of these procedures. The indicators in these guidelines were compiled on the instructions of the NVvH.

Overview of indicators

Two indicators were developed; process indicators.

	Indicator	Type
1	Preoperative multidisciplinary meeting	Process indicator
2	Time to first debridement	Process indicator

The indictors are further defined below

Fact sheet indicators

1. Preoperative multidisciplinary meeting

1. Preoperative multidisciplinary meeting
Operationalisation	What percentage of patients with a grade III open fracture of the lower limb are discussed preoperatively at a multidisciplinary meeting comprising orthopaedic / trauma surgeon, plastic surgeon and rehabilitation physician?
Numerator	The number of patients with a grade III open fracture of the lower limb that are discussed preoperatively at a multidisciplinary meeting comprising orthopaedic / trauma surgeon, plastic surgeon and rehabilitation physician.
Denominator	Number of patients with a grade III open fracture of the lower limb
Type of indicator	Process indicator
Inclusion and exclusion criteria	Inclusion criteria: All patients with a grade III open fracture of the lower limb Exclusion criteria: Patients with a grade III open fracture of the lower limb but no loss of tissue were excluded from this indicator
Quality domain	Effectiveness: delivery of rigorous and correct care based on expert knowledge
Frequency of measurement	The data for this indicator are measured continuously
Report year	Data concerning the particular year under review are requested. The Report year is the year over which the hospital reports data
Report frequency	Once a year

Remarks

Background and variation in care

Care for patients with a grade III open fracture of the lower limb benefits from a multidisciplinary approach in which the expertise of a number of providers is taken into consideration in drawing up a treatment plan.

This indicator is aimed at gaining access and knowledge of the care process and at making comparisons between hospitals. This information can be used to further improve the care process.

Definitions

Multidisciplinary team: presence of an orthopaedic/trauma surgeon, a plastic surgeon and a rehabilitation physician (on indication).

Preoperatively: prior to first debridement.

Registration burden

The time requirement for registration is acceptable. The working party is of the opinion that the time investment necessary to register the results of treatment equals the value of the indicator. The use of the existing DBC-DOT-ICD10-CBV Dutch information coding system will lighten the burden of registration thus improving reliability.

Potentially disruptive factors

There are no potentially disruptive factors

Possible adverse effects

A potential adverse effect is the postponement of a reconstruction due to the unavailability of the multidisciplinary team. The working party has concluded that the availability of a multidisciplinary team takes precedence over the 6-hour rule. Therefore reconstruction can be postponed if the multidisciplinary team is unavailable. However, it is strongly recommended that care be organised in such a way that both recommendations can be adhered to. This can be achieved by arranging 24-hour availability of the team.

2. Time to first debridement

Time to first debridement
Operationalisation	Time between admission of a patient with a grade III open fracture of the lower limb to an emergency department and first debridement
Numerator	Time between admission of a patient with a grade III open fracture of the lower limb at an emergency department and first debridement
Denominator	Not applicable.
Type of indicator	Process indicator
Inclusion and exclusion criteria	Inclusion: All patients with a grade III open fracture of the lower limb Exclusion: Patients who die between admission and first debridement. Patients in whom the decision for primary amputation is made. Patients who are not seen by an multidisciplinary team preoperatively as described in indicator 1 (preoperative multidisciplinary discussion).
Quality domain	Effectiveness: delivery of rigorous and correct care based on expert knowledge Timeliness: the provision of care within a certain time frame
Frequency of measurement	The data for this indicator are collected continuously
Year of report	Data concerning the particular year under review are requested. The Report year is the year over which the hospital reports data
Report frequency	Once a year

Remarks

Background and variation in care

The longer the time to debridement, the higher the risk of infection, reoperation and amputation. This indicator is aimed at gaining access to and knowledge of the care process and at making comparisons between hospitals. This information can be used to further improve the care process.

Definitions

Time of first debridement: registered time of incision in operating theatre

Registration burden

Potentially disruptive factors

There are no potentially disruptive factors

Possible adverse effects

One possible adverse effect is omitting a preoperative multidisciplinary meeting in order to shorten the time to first debridement. The working party has concluded that the availability of a multidisciplinary team takes precedence over the 6-hour rule. Therefore reconstruction can be postponed if the multidisciplinary team is unavailable. However, it is strongly recommended that care be organised in such a way that both recommendations can be adhered to. This can be achieved by arranging 24-hour availability of the team.

3. Time to definitive reconstruction

Time to definitive reconstruction
Operationalisation	Time from admission of a patient with a grade III open fracture of the lower limb to an emergency department to definitive reconstruction
Numerator	Time from admission of a patient with a grade III open fracture of the lower limb to an emergency department to definitive reconstruction
Denominator	Not applicable.
Type of indicator	Process indicator
Inclusion and exclusion criteria	Inclusion: All patients with a grade III open fracture of the lower limb Exclusion: Patients who die between admission and definitive reconstruction Patients who are not seen by an multidisciplinary team preoperatively as described in indicator 1 (preoperative multidisciplinary meeting)
Quality domain	Effectiveness: delivery of rigorous and correct care based on expert knowledge Timeliness: the provision of care within a certain time frame
Frequency of measurement	Data required for the indicators are continuously collected (for some indicators)
Year of report	Data concerning the particular year under review are requested The Report year is the year over which the hospital reports data
Report frequency	Once a year

Remarks

The chance of successful reconstruction is higher if definitive reconstruction takes place within two weeks. This indicator is aimed at gaining access and knowledge of the care process and at making comparisons between hospitals. This information can be used to further improve the care process.

Definitions

Time of definitive reconstruction: the time point at which the soft tissues are closed both with and without local perforator flaps or free pediculated flaps.

Registration burden

Potentially disruptive factors

There are no potentially disruptive factors.

Possible adverse effects

None