Table 1.

Detailed overview of the 10 quality indicators (QI) consented and published by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) [5]. Translated and adapted with permission of the authors

QI I	Safety protocols according to the Declaration of Helsinki
Data source	Safety protocols/standard operation procedures (SOP)
Sample	Availability of all safety protocols according to the Helsinki Declaration:
	– Checking equipment and drugs	– Preoperative assessment and preparation
	– Syringe labelling	– Massive hemorrhage
	– Postoperative care including pain relief	– Infection control and prevention
	– Anaphylaxis	– Malignant hyperpyrexia
	– Local anesthetic toxicity	– Difficult airway/failed intubation
Benchmark	7 out of 10 items: yes/no
QI II	DGAI’s core dataset 3.X compatible anesthesia record
Data source	Anesthesia record
Sample	All 66 items of the DGAI’S anesthesia core dataset 3.x need to be included in the local anesthesia record
Benchmark	Yes/no
QI III	Incident management system
Data source	Minutes of critical incident reporting system (CIRS) and/or morbidity and mortality (M&M) conference and/or documented case report
Sample	All of the above
Benchmark	At least 4min of CIRS and/or M&M and/or documented case reports per year (two per half-year): yes/no
QI IV	Patient blood management (PBM)
Data source	Presence of measures included in PBM at the institution:
	– Preoperative anemia diagnostic and therapy	– SOP PBM
	– Preoperative coagulation assessment	– SOP transfusion of blood products
	– Hemotherapy algorithm	– SOP massive transfusion (e.g. postpartum haemorrhage, trauma)
	– Measures to reduce diagnostic blood loss	– Documentation of indications for blood transfusion
	– Periodic PBM/hemotherapy education	– Regular reporting (e.g. incidence of anemia, consumption of blood products)
Benchmark	2 out of 10 items: yes/no
QI V	Temperature management
Data source	Anesthesia record/patient data management system (PDMS): audit of 50 consecutive records
	Interview of head of department
Sample	– Documented intraoperative temperature recording in >80% of audited interventions >½ h
	– Core body temperature >36 °C at end of surgery in >70% of audited interventions
	– SOP temperature management available
Benchmark	3 out of 3 items: yes/no
QI VI	Safe surgery checklist according to the World Health Organization (WHO)
Data source	Interview of head of department
	Patient protocol: audit of 50 consecutive protocols
Sample	– WHO safe surgery checklist in patient protocol by default
	– WHO safe surgery checklist completed in >95% of sample
Benchmark	2 out of 2 items: yes/no
QI VII	Perioperative morbidity and mortality report
Data source	Interview of head of department
	Anesthesia record: audit of 50 consecutive records
Sample	Presence of item querying:
	– Mortality (24 h postoperative)	– Visual analogue scale (VAS) >3 when discharged from post anesthetic care unit (PACU)
	– Aspiration	– Postoperative nausea and vomiting (PONV)
	– Puncture-related lesion
	– Awareness
	– Patient positioning injury
	– Items completed in >95% of sample yes/no
Benchmark	8 out of 8 items: yes/no
QI VIII	Handover and discharge protocols
Data source	Interview of head of department
	Anesthesia record/patient protocol: audit of 50 consecutive records/protocols
Sample	– SOP/instruction for handover and discharge protocol in clinical routine
	– Items completed in >95% of sample
Benchmark	2 out of 2 items: yes/no
QI IX	Postoperative anesthesiologic visit
Data source	Interview of head of department
Sample	SOP/instruction for postoperative visit in clinical routine
Benchmark	Standard: yes/no
QI X	Physician staffing according to DGAI recommendations
Data source	Interview of head of department
Sample	– Ratio anesthetist:patient 1:1 = 100%; yes/no
	– Ratio supervisor:junior resident in the first 3 months of anesthesia training 1:1 or 1:2 = 100%; yes/no
Benchmark	2 out of 2 items: yes/no