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. 2025 Jan 8;25(1):43.
doi: 10.1186/s12913-024-12194-3.

Development of a pandemic-related core set of quality indicators for quality and patient safety in University Hospitals in Germany

Janis Evers  1 , Natalie Altschuck  2   3 , Claudia Mehl  2 , Lilly Rüthrich  4 , Lorenz Harst  4 , Felix Walther  4 , Oliver Steidle  5 , Arnt Suckow  6 , Ruth Hecker  5 , Jochen Schmitt  4 , Max Geraedts  2
Affiliations

Development of a pandemic-related core set of quality indicators for quality and patient safety in University Hospitals in Germany

Janis Evers et al. BMC Health Serv Res. .

Abstract

Background: The COVID-19 pandemic entailed a global health crisis, significantly affecting medical service delivery in Germany as well as elsewhere. While intensive care capacities were overloaded by COVID cases, not only elective cases but also non-COVID cases requiring urgent treatment unexpectedly decreased, potentially leading to a deterioration in health outcomes. However, these developments were only uncovered retrospectively. Especially university hospitals, which were meant to take on a central coordinating role, did not have detailed information on expected healthcare utilization, available resources and capacities, and the quality of medical care. The experience of compromised healthcare and a lack of monitoring during the COVID-19 pandemic made it clear that healthcare systems should be better prepared. Therefore, the aim of this work was to develop a set of indicators suited to detect undesirable developments concerning the provision of inpatient healthcare.

Material & methods: The study employed a literature review, online surveys, expert interviews, and a multistep evaluation process to develop a core set of quality indicators (QIs) suitable for assessing the resilience of university hospitals during pandemics. This initial set of indicators was refined through consultations with a) quality and risk management officials from German university hospitals via an online survey and b) a diverse panel of experts.

Results: The comprehensive evaluation identified two primary strands: organizational/management indicators (Strand A, 60 indicators) and disease-specific clinical quality and patient safety indicators (Strand B, 20 indicators for critical conditions like stroke, myocardial infarction, and cancer.) Three additional indicators were added after a final expert panel meeting, resulting in a final set of 83 indicators.

Discussion and conclusion: The developed QIs mark a significant advancement in the operational preparedness of university hospitals for pandemics. The study contributes to quality management in healthcare during pandemics by creating the basis for a structured approach to pandemic preparedness and response. This unique set of QIs within the German context presents an opportunity for establishing quality improvement, underscoring the importance of a robust, adaptable quality management framework as a basis for safeguarding against future health crises.

Keywords: COVID-19; Healthcare quality management; Pandemic; Patient safety; Quality indicators; University hospitals.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was reviewed by the Ethics Committee of Philipps-University Marburg (Reference Number: 24–352 ANZ). It was confirmed that no ethical approval was necessary, as the study does not involve human participants, human data, or human tissue, but only professional statements from experts. The interviews were conducted with quality managers from hospitals that are cooperation partners within the multicenter study network, and therefore no consent was required. The dataset excludes any patient or person-related data, in accordance with §15 of Germany's Professional Code for Physicians, which exempts such studies from requiring both ethics committee approval and informed consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overview of the complete workflow for the creation of the indicator set
Fig. 2
Fig. 2
Development process for strand A and B. IGO = International/Governmental-Organizations, here WHO, CDC & NHS; egePan = Development, testing and implementation of regionally adaptive care structures and processes for evidence-based pandemic management coordinated by University Medicine; QM = Quality management; RM = Risk management; QI = Quality indicators; N = Numbers/Quantity
See this image and copyright information in PMC

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