St. Josefs Krankenhaus Hilden

Quality results

Treatment sector: Pressure ulcer (decubitus): prevention through nursing measures (DEK)

Information about this treatment area (documentation)

Designation	Dekubitusprophylaxe
Shortcut	DEK
Number of cases	172
Documentation rate	100.58 %

Summary result:

No assessment is possible for one quality characteristic

Number of patients treated: 172

Quality objective achieved
Quality objective not achieved

The results in detail

Show national result

Quality criterion

Hospital result
and target area

Quality objective
achieved?

All information

So few patients developed moderate pressure ulcers (grade 2) in hospital

Hospital: Data protection

No information due to data protection

as rarely as possible

Evaluation is not available

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So few patients developed severe pressure ulcers (grade 3) in hospital

Hospital: Data protection

No information due to data protection

as rarely as possible

Evaluation is not available

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So rarely did patients develop pressure ulcers of unknown severity in hospital

Hospital: Data protection

No information due to data protection

as rarely as possible

Evaluation is not available

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So rarely did a very severe pressure ulcer (grade 4) develop during the hospital stay

Hospital: Data protection

No information due to data protection

Sentinel Event

Assessment not possible

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Code ID	52326
Result (%)	Data protection
Evaluation through structured dialogue
Population	Data protection
Events observed	Data protection
Anticipated events	Data protection
Result trend compared with the previous reporting year
Comparison with the previous reporting year
National result (%)	0,36
Target range (reference range)
Confidence interval nationwide (%)	0,36 - 0,37
Hospital confidence interval (%)	0,00 - 0,00
Reference infection	No
Type of value	TKez
Relation to the procedure	DeQS
Reference to other QA results
Sorting
Risk-adjusted rate
Comments/explanations by the competent authority at national or state level
Comments/explanations by the hospital
Specialist note IQTIG Although indicators represent quality, their results do not allow a direct assessment of the quality of care (due to the lack of a reference range) and they are not suitable for direct quality comparisons (due to the lack of mathematical adjustment). However, they are usually published in direct connection with a quality indicator, the results of which are supplemented by the indicator values (imputed and supplementary indicators). They thus contribute to an increase in the comprehensibility of the quality results. The transparency indicators, which are to be distinguished from these, represent aspects of care for which there are no quality indicators, but which are nevertheless important for presenting the quality of care. More detailed information on ratios can be found at the following link: https://iqtig.org/veroeffentlichungen/kennzahlenkonzept.

Code ID	521801
Result (%)	Data protection
Evaluation through structured dialogue
Population	Data protection
Events observed	Data protection
Anticipated events	Data protection
Result trend compared with the previous reporting year
Comparison with the previous reporting year
National result (%)	0,07
Target range (reference range)
Confidence interval nationwide (%)	0,06 - 0,07
Hospital confidence interval (%)	0,00 - 0,00
Reference infection	No
Type of value	TKez
Relation to the procedure	DeQS
Reference to other QA results
Sorting
Risk-adjusted rate
Comments/explanations by the competent authority at national or state level
Comments/explanations by the hospital
Specialist note IQTIG Although indicators represent quality, their results do not allow a direct assessment of the quality of care (due to the lack of a reference range) and they are not suitable for direct quality comparisons (due to the lack of mathematical adjustment). However, they are usually published in direct connection with a quality indicator, the results of which are supplemented by the indicator values (imputed and supplementary indicators). They thus contribute to an increase in the comprehensibility of the quality results. The transparency indicators, which are to be distinguished from these, represent aspects of care for which there are no quality indicators, but which are nevertheless important for presenting the quality of care. More detailed information on ratios can be found at the following link: https://iqtig.org/veroeffentlichungen/kennzahlenkonzept.

Code ID	521800
Result (%)	Data protection
Evaluation through structured dialogue
Population	Data protection
Events observed	Data protection
Anticipated events	Data protection
Result trend compared with the previous reporting year
Comparison with the previous reporting year
National result (%)	0,01
Target range (reference range)
Confidence interval nationwide (%)	0,01 - 0,01
Hospital confidence interval (%)	0,00 - 0,00
Reference infection	No
Type of value	TKez
Relation to the procedure	DeQS
Reference to other QA results
Sorting
Risk-adjusted rate
Comments/explanations by the competent authority at national or state level
Comments/explanations by the hospital
Specialist note IQTIG Although indicators represent quality, their results do not allow a direct assessment of the quality of care (due to the lack of a reference range) and they are not suitable for direct quality comparisons (due to the lack of mathematical adjustment). However, they are usually published in direct connection with a quality indicator, the results of which are supplemented by the indicator values (imputed and supplementary indicators). They thus contribute to an increase in the comprehensibility of the quality results. The transparency indicators, which are to be distinguished from these, represent aspects of care for which there are no quality indicators, but which are nevertheless important for presenting the quality of care. More information on indicators can be found at the following link: https://iqtig.org/veroeffentlichungen/kennzahlenkonzept. According to current knowledge, the classification of a pressure ulcer can be done according to the WHO (DIMDI) as well as according to NPUP/EPUAP. The classification according to EPUAP/NPUAP describes the categories Cannot be assigned to a category/stage: depth unknown and Suspected deep tissue damage: Depth unknown. Therefore, suspected deep tissue damage may have been documented as pressure ulcer, stage unspecified.

Code ID	52010
Result (%)	Data protection
Evaluation through structured dialogue	An evaluation is not possible because there were no patients in the hospital to whom this quality criterion could be applied. (N01)
Population	Data protection
Events observed	Data protection
Anticipated events	Data protection
Result trend compared with the previous reporting year	eingeschränkt/nicht vergleichbar
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	0,01
Target range (reference range)	Sentinel Event
Confidence interval nationwide (%)	0,01 - 0,01
Hospital confidence interval (%)	0,00 - 0,00
Reference infection	No
Type of value	QI
Relation to the procedure	DeQS
Reference to other QA results
Sorting
Risk-adjusted rate
Comments/explanations by the competent authority at national or state level
Comments/explanations by the hospital
Specialist note IQTIG It should be noted that this computational result may not be influenced exclusively by the respective institution. So e.g. the disease severity or concomitant diseases of the patients have an influence on the result. The reference range indicates the range in which the results of an indicator are assessed as normal. A facility with a result outside the reference range is initially computationally conspicuous, which usually results in an analysis in the structured dialog. It should be noted that an indicator result outside the reference range is not synonymous with a poor quality of the facility in the quality aspect considered here. The deviation can also e.g. be traceable to incorrect documentation or to individual cases. Quality is assessed in the context of the structured dialogue with the institutions.