Table 1.
Proposed quality indicators for a cardiology or cardiac surgery department
| No. | Indicator | Frequency | Benchmark |
|---|---|---|---|
| General hospitalization metrics | |||
| 1 | No. of administrative admissions/no. of actual admissions/percentage of circulating patients (in different units)a | Quarterly | 3500/< 2500/< 40% |
| 2 | Attendance (no. of admissions/1000 pop.) | Annual | ≤ 6/1000 |
| 3 | Percentage of elective admissions | Quarterly | > 25% |
| 4 | Average waiting time in emergency department after admission is decided | Quarterly | < 4 h |
| 5 | Average length of admission | Quarterly | < 5 d |
| 6 | Percentage of hospital occupancy | Quarterly | < 85% |
| 7 | Mortality rate | Weekly | < 4% |
| 8 | Percentage of hospital discharges | Quarterly | > 90% |
| 9 | Percentage of readmissions before 8 d | Annual | < 5% |
| 10 | Percentage of readmissions before 30 d | Annual | < 10% |
| 11 | Percentage of surveyed patients satisfied or very satisfied | Annual | 95% |
| 12 | Rate of complaints (no. of complaints/no. of admissions × 100) | Annual | < 1% |
| Conventional hospitalization metrics | |||
| 13 | No. of conventional admissions | Quarterly | < 2000 |
| 14 | Percentage of elective admissions | Quarterly | 25%-35% |
| 15 | Percentage of transfers from other hospital areas | Quarterly | < 40% |
| 16 | Average length of stay in the conventional hospital unit (admissions from emergency department) | Quarterly | < 8 d |
| 17 | Percentage of conventional hospital occupancy | Quarterly | < 85% |
| 18 | Percentage of hospital discharges from conventional hospitalization (not elective) | Quarterly | > 80% |
| 19 | Mortality rate of conventional admissions | Quarterly | < 2% |
| 20 | Percentage of medical complications during conventional admissions | Quarterly | < 15% |
| 21 | No. of conventional hospital readmissions before 8 d | Annual | < 5% |
| 22 | No. of falls/1000 conventional hospital admissions | Quarterly | < 1% |
| Critical care cardiology unit metrics | |||
| 23 | No. of coronary unit admissions | Quarterly | < 1000 |
| 24 | Percentage of transfers from other hospital areas | Quarterly | < 30% |
| 25 | Percentage occupancy | Quarterly | < 90% |
| 26 | Average length of stay | Quarterly | < 3 d |
| 27 | Pneumonia associated with CMV | Annual | 18/1000 d of CMV |
| 28 | Percentage of hospital discharges (alive) | Quarterly | < 10% |
| 29 | Mortality rate | Quarterly | < 5% |
| 30 | Mortality rate due to ST-segment elevation AMI in the critical care cardiology unit | Annual | < 5% |
| 31 | Mortality rate due to cardiogenic shock | Annual | < 30% |
| Intermediate care metrics | |||
| 32 | No. of intermediate care admissions | Quarterly | > 500 |
| 33 | Percentage of transfers to intermediate care from other hospital areas | Quarterly | > 60% |
| 34 | Percentage occupancy | Quarterly | < 90% |
| 35 | Average length of stay | Quarterly | < 5 d |
| 36 | Mortality rate | Quarterly | < 3% |
| Chest pain unit metrics | |||
| 37 | Door-to-ECG time for patients with chest pain < 10 min | Annual | > 90% |
| 38 | Readmissions less than 72 h after discharge from chest pain unit | Annual | < 1% |
| Outpatient care metrics | |||
| 39 | Rate of visits from outpatient clinics: no. of first face-to-face consultations | Annual | > 15/1000 pop./y (7000/y) |
| 40 | Ratio of successive/first visits (excluding devices and congenital and valve diseases) | Annual | < 1.5 |
| 41 | No. of e-consultations (remote consultations conducted with a unique electronic medical record) | Annual | > 5000 |
| 42 | Percentage of e-consultations that are discharges | Annual | > 20% |
| 43 | Average wait for e-consultation | Annual | < 4 d |
| 44 | Average wait for one-stop clinic | Annual | < 15 d |
| 45 | Average wait for first heart failure-related consultation | Annual | 30 d |
| 46 | Average wait for first device-related consultation | Annual | < 30 d |
| 47 | Average wait for first valve-related consultation | Annual | < 60 d |
| 48 | Average wait for first consultation for congenital and familial heart disease | Annual | < 60 d |
| 49 | Average wait for first cardio-oncology-related consultation | Annual | < 15 d |
| 50 | Percentage of hospital discharges after the first consultation (same-day diagnosis) | Annual | > 70% |
| 51 | Percentage of discharges from follow-up consultations for general conditions (excluding devices and congenital and valve diseases) | Annual | > 15% |
| 52 | Care time delay (appointment-resolution time) | Annual | < 120 min |
| Cardiac surgery process metrics | |||
| 53 | No. of major cardiac surgeries/y | Annual | > 450 |
| 54 | 30-d mortality rate after major cardiac surgery | Annual | < 5% |
| 55 | Mortality rate from bypass surgery alone | Annual | < 3% |
| 56 | Mortality rate from aortic valve surgery (excluding endocarditis) | Annual | < 5% |
| 57 | Mortality rate from mitral valve disease alone (excluding endocarditis) | Annual | < 10% |
| 58 | Percentage of surgeries performed more than 60 d after being accepted (for nonmedical reasons) | Annual | 0% |
| Acute coronary syndrome metrics | |||
| 59 | In-hospital mortality rate of patients with ST-segment elevation acute coronary syndrome | Annual | < 5% |
| 60 | In-hospital mortality rate of patients with non-ST-segment elevation acute coronary syndrome | Annual | < 2% |
| 61 | 30-d in-hospital mortality rate of patients with ST-segment elevation acute coronary syndrome | Annual | < 6% |
| 62 | In-hospital mortality rate of myocardial infarction | Annual | < 3% |
| 63 | Percentage of reperfusion of ST-segment elevation myocardial infarction | Annual | > 80% |
| 64 | Percentage of primary angioplasties in the first 60 min after hospital arrival | Annual | > 70% |
| 65 | Percentage of readmissions less than 30 d after discharge for myocardial infarction | Annual | < 5% |
| 66 | Percentage of acute in-stent thromboses after primary angioplasty | Annual | < 3% |
| 67 | Average length of stay of patients with ST-segment elevation AMI | Annual | < 6 d |
| 68 | Average length of stay of patients with non–ST-segment elevation AMI | Annual | < 6 d |
| 69 | Average length of stay of patients with AMI | Annual | < 6 d |
| Heart failure process metrics | |||
| 70 | In-hospital mortality rate of patients admitted for heart failure | Annual | < 8% |
| 71 | Percentage of readmissions less than 30 d after discharge for heart failure | Annual | < 10% |
| 72 | Average length of stay of heart failure patients | Annual | < 8 d |
| 73 | Bed occupancy percentage in the HF unit | Annual | < 85% |
| 74 | No. of patients discharged from the hospital via the HF unit with a first diagnosis other than HFb | Annual | < 30 |
| 75 | No. of patients discharged from the hospital via the HF unit with a first diagnosis of HFb | Annual | < 50 |
| 76 | Percentage of hospital discharges from the HF unit of patients with a HF diagnosisb | Annual | > 85% |
| Atrial fibrillation process metrics | |||
| 77 | Percentage of electrical cardioversions performed within 45 d of patients being placed on the waiting list | Annual | 100% |
| 78 | Percentage of pulmonary vein ablation procedures | Annual | > 100% |
| 79 | Percentage of major AF ablation-related complications | Annual | < 3% |
| Aortic stenosis process metrics | |||
| 80 | Percentage of patients undergoing surgery more than 30 d after surgery was agreed | Annual | 0% |
| 81 | Percentage of patients undergoing TAVI more than 30 d after TAVI was agreed | Annual | 0% |
| Infective endocarditis process metrics | |||
| 82 | In-hospital mortality rate due to infective endocarditis | Annual | < 25% |
| 83 | Surgical mortality rate of patients admitted for infective endocarditis | Annual | < 25% |
| 84 | Incidence of infective endocarditis | Annual | < 10/100 000 |
| 85 | Surgical treatment of infective endocarditis | Annual | > 40% |
| 86 | Incidence of health care-associated endocarditis | Annual | < 5/100 000 |
| Cardiac arrest process metrics | |||
| 87 | Survival after aborted out-of-hospital cardiac arrest | Annual | > 50% |
| 88 | Survival after aborted in-hospital cardiac arrest | Annual | > 70% |
| 89 | Percentage of cardiac arrest patients undergoing therapeutic hypothermia (with the appropriate indication) | Annual | > 90% |
| Imaging unit metrics | |||
| 90 | Frequency (no. of comprehensive echocardiograms per 1000 pop.) | Annual | < 20 (< 9000) |
| 91 | No. of echocardiograms per echocardiographer/y | Annual | > 1900 |
| 92 | No. of stress echocardiograms | Annual | > 400 |
| 93 | No. of transesophageal echocardiograms | Annual | > 800 |
| 94 | Average wait for comprehensive transthoracic echocardiography for patients admitted to cardiology units | Annual | < 1.5 d |
| 95 | Average wait for comprehensive transthoracic echocardiography for outpatients | Annual | < 15 d |
| 96 | Cardiac magnetic resonance scans/y | Annual | > 650 |
| 97 | Cardiac CTs/y | Annual | > 600 |
| Catheterization unit metrics | |||
| 98 | Mortality rate of primary angioplasty (without shock or cardiopulmonary arrest, < 90 y of age) | Annual | < 5% |
| 99 | Mortality rate of elective angioplasty | Annual | < 1% |
| 100 | Mortality rate of TAVI | Annual | < 5% |
| 101 | Percentage of major vascular complications in TAVI | Annual | < 10% |
| 102 | Percentage of TAVI conversions to heart surgery | Annual | < 1% |
| 103 | Catheterization delay for outpatients | Annual | < 30 d |
| 104 | No. of outpatient angioplasties | Annual | > 100 |
| Electrophysiology unit metrics | |||
| 105 | Rate of major complications in complex procedures | Annual | < 5% |
| 106 | Mortality rate in ICD, PM, and resynchronization device implantations | Annual | < 1% |
| 107 | No. of patients with need for urgent PM with a delay > 24 h | Annual | < 1% |
| 108 | No. of patients needing a programmed PM, ICD, or resynchronization device with a delay > 30 d | Annual | 0% |
| 109 | No. of outpatient procedures (except PM replacements and cardioversions) | Annual | > 200 |
| Cardiac rehabilitation metrics | |||
| 110 | No. of days between discharge for acute coronary syndrome and first visit for cardiac stress test | Annual | < 30 d |
| 111 | Percentage of patients with AMI directed to the cardiac rehabilitation program | Annual | > 90% |
AF, atrial fibrillation; AMI, acute myocardial infarction; CMV, controlled mechanical ventilation; CT, computed tomography; HF, heart failure; ICD, implantable cardioverter-defibrillator; PM, pacemaker; pop., population; TAVI, transcatheter aortic valve implantation.
a
Percentage of circulating patients refers to patients that were admitted to > 1 service unit during the same hospitalization.
b
In this case, the 3 metrics are applied to identify the occupancy of beds intended for the treatment of heart failure used for other cardiovascular conditions.