Asklepios Harzklinik Goslar

Quality results

Treatment sector: Cardiac catheter applications

Information about this treatment area (documentation)

Designation	Perkutane Koronarintervention und Koronarangiographie (LKG)
Shortcut	PCI_LKG
Number of cases	650
Documentation rate	101.38 %

Summary result:

In 11 of 13 quality characteristics, the quality objective was achieved.
No assessment is possible for any quality characteristic

Number of patients treated: 650

Quality objective achieved
Quality objective not achieved

The results in detail

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Quality criterion

Hospital result
and target area

Quality objective
achieved?

All information

So often catheter examinations were well justified because coronary vessels were actually so severely narrowed that treatment was necessary

National result: 64,25 %
Hospital: 10,00 %

Target area: at least 40,97 %

Quality objective not achieved

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This is how rarely cardiac catheter examinations were performed, even though there was no pathological narrowing of the coronary arteries

National result: 27,91 %
Hospital: 55,56 %

Target area: at most 41,48 %

Quality objective not achieved

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This is how often the balloon catheter procedure started within the first hour after admission to hospital

National result: 76,37 %
Hospital: 83,33 %

Target area: at least 67,57 %

Quality objective achieved

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So rarely was the time of arrival of patients at the hospital or the start of the balloon catheter procedure not recorded in writing

National result: 2,71 %
Hospital: 7,69 %

Target area: at most 5,98 %

Quality objective achieved

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Ratio of actual to expected rate of increased radiation exposure during a cardiac catheterisation examination (over 2,800 cGy x cm2)

National result: 0,89
Hospital: 1,40

Target area: at most 1,65

Quality objective achieved

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Ratio of actual to expected rate of increased radiation exposure for balloon catheter treatment (over 4,800 cGy x cm2)

National result: 0,94
Hospital: 1,92

Target area: at most 1,14

Quality objective achieved

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Ratio of actual to expected rate of increased radiation exposure during a cardiac catheter examination with directly subsequent balloon catheter treatment (over 5,500 cGy x cm2)

National result: 0,90
Hospital: 0,92

Target area: at most 1,50

Quality objective achieved

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It is rare that the radiation exposure of patients during a cardiac catheterisation procedure is not recorded in writing.

National result: 0,21 %
Hospital: 0,59 %

Target area: at most 0,15 %

Quality objective achieved
Why?

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So rarely has the recommended amount of contrast medium been exceeded during cardiac catheter examinations (max. 150 ml)

National result: 4,41 %
Hospital: 8,62 %

Target area: at most 6,86 %

Quality objective achieved

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So rarely has the recommended amount of contrast medium been exceeded in balloon catheter treatments (max. 200 ml)

National result: 17,16 %
Hospital: Data protection

No information due to data protection

Target area: at most 21,93 %

Quality objective achieved

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So rarely has the recommended amount of contrast medium been exceeded (max. 250 ml) during a cardiac catheter examination with directly subsequent balloon catheter treatment.

National result: 9,88 %
Hospital: 23,31 %

Target area: at most 16,84 %

Quality objective achieved
Why?

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This is how often blood flow improved in patients with sudden severe symptoms and suspected heart attacks

National result: 94,29 %
Hospital: 92,73 %

Target area: at least 93,65 %

Quality objective achieved

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So often blood flow improved due to the cardiac catheterisation procedure (all patients)

National result: 95,31 %
Hospital: 97,64 %

Target area: at least 93,95 %

Quality objective achieved

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Code ID	56000
Result (%)	10,00
Evaluation through structured dialogue	The result is not in the target area. The hospital did not meet the quality target. It has not given sufficient explanatory reasons for the deviation from the target area. (A72)
Population	70
Events observed	7
Anticipated events	0,00
Result trend compared with the previous reporting year	verschlechtert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	64,25
Target range (reference range)	>= 40,97 % (5. Perzentil)
Confidence interval nationwide (%)	64,05 - 64,45
Hospital confidence interval (%)	4,59 - 18,63
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56001
Result (%)	55,56
Evaluation through structured dialogue	The result is not in the target area. The hospital did not meet the quality target. There are indications of structural and process deficiencies. (A71)
Population	81
Events observed	45
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	27,91
Target range (reference range)	<= 41,48 % (95. Perzentil)
Confidence interval nationwide (%)	27,71 - 28,11
Hospital confidence interval (%)	44,70 - 66,02
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	Viele Fälle ohne KHK, massive umfangreiche Fehldokumentation
Comments/explanations by the hospital
Specialist note IQTIG The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56003
Result (%)	83,33
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	48
Events observed	40
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	76,37
Target range (reference range)	>= 67,57 % (5. Perzentil)
Confidence interval nationwide (%)	75,91 - 76,83
Hospital confidence interval (%)	71,00 - 91,79
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56004
Result (%)	7,69
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	52
Events observed	4
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	2,71
Target range (reference range)	<= 5,98 % (95. Perzentil)
Confidence interval nationwide (%)	2,54 - 2,88
Hospital confidence interval (%)	2,65 - 17,26
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56005
Result	1,40
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	403
Events observed	68
Anticipated events	48,57
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result	0,89
Target range (reference range)	<= 1,65 (95. Perzentil)
Confidence interval nationwide	0,88 - 0,90
Hospital confidence interval	1,10 - 1,76
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 Risk adjustment aims to compensate for the different patient structure in different facilities. Ideally, this leads to a fair comparison of the different facilities, since patients have individual risk factors (such as concomitant diseases) that systematically influence the quality outcome, without it being possible to attribute responsibility for e.g. resulting more frequent complications to one facility. With the help of risk adjustment, the quality outcome of, for example, an institution with many high-risk cases can be statistically compared more fairly with the quality outcome of an institution with many low-risk cases. More information on risk adjustment can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen. The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered suspicious. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56006
Result	1,92
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	Data protection
Events observed	Data protection
Anticipated events	Data protection
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result	0,94
Target range (reference range)	<= 1,14 (95. Perzentil)
Confidence interval nationwide	0,92 - 0,97
Hospital confidence interval	0,21 - 8,95
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 Risk adjustment aims to compensate for the different patient structures in different facilities. Ideally, this leads to a fair comparison of the different facilities, since patients have individual risk factors (such as concomitant diseases) that systematically influence the quality outcome, without one facility being held responsible for, for example, more frequent complications as a result. With the help of risk adjustment, the quality outcome of, for example, an institution with many high-risk cases can be statistically compared more fairly with the quality outcome of an institution with many low-risk cases. More information on risk adjustment can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen. The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered suspicious. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56007
Result	0,92
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	265
Events observed	39
Anticipated events	42,50
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result	0,90
Target range (reference range)	<= 1,50 (95. Perzentil)
Confidence interval nationwide	0,89 - 0,91
Hospital confidence interval	0,66 - 1,24
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 Risk adjustment aims to compensate for the different patient structure in different facilities. Ideally, this leads to a fair comparison of the different facilities, since patients have individual risk factors (such as concomitant diseases) that systematically influence the quality outcome, without it being possible to attribute responsibility for e.g. resulting more frequent complications to one facility. With the help of risk adjustment, the quality outcome of, for example, an institution with many high-risk cases can be statistically compared more fairly with the quality outcome of an institution with many low-risk cases. More information on risk adjustment can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen. The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered suspicious. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56008
Result (%)	0,59
Evaluation through structured dialogue	Although the result is not in the target area, the quality target is still considered to be achieved, because the deviation can be traced back to one or more well-founded individual cases after examination by specialist committees. (U62)
Population	673
Events observed	4
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	0,21
Target range (reference range)	<= 0,15 % (90. Perzentil)
Confidence interval nationwide (%)	0,20 - 0,22
Hospital confidence interval (%)	0,20 - 1,41
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56009
Result (%)	8,62
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	406
Events observed	35
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	4,41
Target range (reference range)	<= 6,86 % (95. Perzentil)
Confidence interval nationwide (%)	4,35 - 4,47
Hospital confidence interval (%)	6,18 - 11,65
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56010
Result (%)	Data protection
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	Data protection
Events observed	Data protection
Anticipated events	Data protection
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	17,16
Target range (reference range)	<= 21,93 % (95. Perzentil)
Confidence interval nationwide (%)	16,68 - 17,65
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56011
Result (%)	23,31
Evaluation through structured dialogue	Although the result is not in the target area, the quality target is still considered to be achieved, because the deviation can be traced back to one or more well-founded individual cases after examination by specialist committees. (U62)
Population	266
Events observed	62
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	9,88
Target range (reference range)	<= 16,84 % (95. Perzentil)
Confidence interval nationwide (%)	9,77 - 10,00
Hospital confidence interval (%)	18,53 - 28,66
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56014
Result (%)	92,73
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	55
Events observed	51
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	94,29
Target range (reference range)	>= 93,65 % (5. Perzentil)
Confidence interval nationwide (%)	94,05 - 94,52
Hospital confidence interval (%)	83,63 - 97,50
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.

Code ID	56016
Result (%)	97,64
Evaluation through structured dialogue	The result is in the target area - the quality target is therefore considered to have been fully achieved. (R10)
Population	212
Events observed	207
Anticipated events	0,00
Result trend compared with the previous reporting year	unverändert
Comparison with the previous reporting year	eingeschränkt/nicht vergleichbar
National result (%)	95,31
Target range (reference range)	>= 93,95 % (5. Perzentil)
Confidence interval nationwide (%)	95,23 - 95,39
Hospital confidence interval (%)	94,91 - 99,09
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 The reference range indicates the results at which a facility can be assumed to provide good quality of care, although deviations are possible. The reference range thus establishes a benchmark for the evaluation of facilities. A result outside the reference range is initially considered conspicuous. This usually entails an analysis by means of a statement procedure. It should be noted that a quality result outside the reference range is not synonymous with a lack of quality of the facility in the quality aspect considered here. The deviation can also be due, for example, to incorrect documentation, medical specificity of the patient collective or individual cases. The evaluation of quality is carried out within the framework of the defined procedure in the comments procedure. More detailed information on reference areas can be found at the following link: https://iqtig.org/das-iqtig/grundlagen/methodische-grundlagen.