Table 1 Overview of the final quality indicator (QI) set
Quality indicators (n = 26) | Definition | Health care component | Evidence | |
|---|---|---|---|---|
Structural indicators (n = 15) | Comprehensive transition management to weaning centre (from hospital)/ contact to weaning centre/ contact person at weaning centre (S_01) | Reduction of complications within the transition process | Medical | recommendation S2k-guideline |
Acute-hospitalisation of patients (S_02) | Assessment of structured transition of patients in long term care into a hospital | Medical | recommendation S2k-guideline | |
Emergency management and concepts in case of infrastructure deficiencies (S_03) | Assessment of the availability contact dates of relatives, general practitioners, pulmonologist, weaning centre and medical device providers | Medical | recommendation expert | |
Early detection of complications (S_04a) and Complication management (S_04b) | Reduction of complications in case of an emergency for relatives, patients, nursing care facility, other health care providers | Medical | recommendation S2k-guideline | |
Qualification of nursing staff (vocational training and training for intensive care ) (S_05) | Guarantee of high quality of care; assessment of the education of the nursing staff and if necessary qualifications for the treatment of mechanical ventilated patients are obtained | Nursing | recommendation S2k-guideline | |
Nursing staff to patient ratio (ambulatory intensive care - assisted living communities) (S_06) | Guarantee of a professional work environment by adequate staffing; assessment of the numbers of employed nurses and of the patients | Nursing | recommendation expert | |
Qualification and additional qualification of therapists (S_07) | Standard health care; therapeutic measures should only be performed by therapists with permission to own this professional title in Germany | Therapeutic-rehabilitative | recommendation expert | |
Participation of the nursing facility in external quality circles (S_10) | Guarantee of high quality of care by regular training; assessment if the nursing facility takes part in external boards and if they are in regular exchange with other facilities, thereby stays up-to-date regarding recent changes and demands and strives to improve to own quality of care | Nursing | recommendation expert | |
Interdisciplinary case conferences (S_11) | Assessment of regularly performed and documented multidisciplinary (at least: pulmonologist, general practitioner and breathing therapist) case conferences | Medical | recommendation expert | |
Hygiene plan and concept (S_12a) and training of nursing staff regarding hygiene (S_12b) | Infection prevention and assessment of medical care | Medical | recommendation S2-guideline | |
Access to endoscopic dysphagia diagnostic equipment (S_14) | Appropriate assessment of dysphagia and coordinated therapeutic measures | Therapeutic-rehabilitative | recommendation expert | |
Offered social care/ social care used by patients (S_15) | Assessment if social participation is promoted by the nursing care facility and if it is used by the patients | Nursing | recommendation expert | |
Assessment of QoL (quality of life, social participation, activity of living) (S_16) | Considering the effect of mechanical ventilation on patients' quality of life, participation in social life and daily activities) | Nursing/ Therapeutic-rehabilitative | recommendation S2k-guideline | |
Process indicators (n = 8) | Comprehensive transition and discharge management into long-term care (P_01) | Reduction of complications during the transition (patient level) | Medical | recommendation S2k-guideline |
Induction of informal caregivers by nursing team (P_02) | Improvement of processes in the home care setting, optimal patient care by training of relatives, increase in patients' participation in social life, support regarding prevention/reduction of concomitant diseases and complications | Nursing/ Therapeutic-rehabilitative | recommendation S2k-guideline | |
Patients' say in choosing they nursing specialist and therapists (P_05) | The patient should choose their nursing specialist and therapists, to guarantee a continuous and appropriate care for the patients | Nursing | recommendation S2k-guideline | |
Guaranteed supply of therapeutic measures and continuous therapy sequence (P_07) | The patient receives physiotherapy, occupational and speech therapy within a defined time period (with defined therapy sequence and without pauses) | Therapeutic-rehabilitative | recommendation expert | |
Mobilisation of the patient (P_11) | Provision of activating care | Medical | recommendation S2k-guideline | |
Follow-up visit of patients at the initiating weaning centre (P_14) | Optimisation of mechanical ventilation settings | Nursing | recommendation S2k-guideline | |
Needs assessment by an external assessor (P_15) | Guaranteed optimal care situation | Nursing/ Therapeutic-rehabilitative | recommendation S2k-guideline | |
Inter-professional cooperation (P_16) | The therapeutic concept is coordinated between all therapeutic groups; all responsible health care professions meet regularly | Therapeutic-rehabilitative | recommendation expert | |
Outcome indicators (n = 3) | Number of hospital admissions (O_05) | Detection of complications in the intensive care; assessment of the proportion of patients that had to be re-admissioned to a hospital due to worsening of the underlying disease or due to an incident disease | Nursing | recommendation S2k-guideline |
Complication rate (O_06) | Reporting defined complications | Medical/ Nursing/ Therapeutic-rehabilitative | recommendation S2k-guideline | |
Cases for which the extend of nursing care could be reduced (O_08) | Recording of reduction of scope of nursing care | Nursing | recommendation S2k-guideline | |