Treatments and diagnostic tests

Hospital quality assurance in Germany: The areas of care in 2014

A hospital's quality can only be assessed once the treatment outcomes are known for all patients. Quality reports contain these treatment outcomes, but information on quality assurance is only documented for certain areas of care. The following table lists these areas and which set of services belong to each.

Table: Areas of care and services in hospital quality reports in 2014
Area of care Service Explanation
Carotid
artery
  • Carotid revascularization
The flow of blood through the carotid artery is restored. This is done by either surgically removing deposits or calcified plaques, or expanding the narrowed site with a cardiac catheter.
Lungs
  • Lung transplant and heart-lung transplant
The healthy lung of a recently deceased donor is transplanted to another person. A combined heart-lung transplant is an option for people who have heart damage as well as severe lung disease.
Lungs If you develop pneumonia outside of the hospital environment, it is called "community-acquired" pneumonia – as opposed to "hospital-acquired" pneumonia. The difference is important because the two types are caused by different bacteria, so different antibiotics are used for treatment.
Breast
  • Breast surgery
Breast surgery refers to any type of surgery performed on the mammary gland. This mainly includes surgery performed on women who have been diagnosed with breast cancer.
Heart Pacemaker:
  • Implantation
  • Pulse generator replacement
  • Revision / System change / Explantation

A pacemaker is a device that uses electrical impulses to help keep the heart beating regularly. Implantation refers to the device being put in. A pacemaker is made up of two parts: a battery-powered pulse generator that is implanted in the chest inside the layer of fat beneath the skin. One or two wires (electrodes) connect it to the muscle tissue in the heart.

 

When the batteries are empty, the pulse generator is replaced.

 

A revision is a check of how well the pacemaker is running – for example in the event of inflammation or bleeding, or if it slips or stops working properly.

 

The removal of a pacemaker is called explantation. A system change occurs when all of the elements are replaced.

Heart

Implantable cardioverter defibrillators (ICD):

  • Implantation
  • Pulse generator replacement
  • Revision / System change / Explantation
An implantable cardioverter defibrillator (ICD) is a small electric device that senses dangerous arrhythmias (irregular heartbeat) and then stops them by using an electric current (defibrillation). It is implanted in the layer of fat below the skin, just like a pacemaker. Another similarity with pacemakers is that a generator replacement, revision, explantation or system change may be needed later on.
Heart
  • Coronary angiography and  ercutaneous coronary intervention (PCI)
Coronary angiography is a special kind of x-ray examination that uses a cardiac catheter and a contrast medium to make the coronary arteries visible. The catheter is usually inserted in the groin area through the skin (percutaneous), and then pushed along a vein until it reaches the heart. Any narrow places found in the arteries can be expanded using a balloon attached to the tip of the cardiac catheter. Sometimes a metal stent is implanted too, to keep the artery from narrowing again. Both of these treatments are also known as percutaneous coronary intervention (PCI).
Heart
  • Aortic valve surgery, isolated
Surgery performed on the heart valve between the left ventricle and the aorta is called aortic valve surgery. The aortic valve prevents blood from flowing back into the heart because it opens only when blood is pumped into the body from the heart. If the valve leaks or is too tight, it can be replaced with an artificial valve.
Heart
  • Coronary surgery, isolated
Surgery performed on the coronary arteries is called coronary surgery. The main type of coronary surgery is a bypass operation: this involves using a healthy segment of blood vessel to re-route the flow of blood around a narrowed part of an artery and allow the blood to reach the muscle tissue of the heart.
Heart
  • Combined coronary and aortic valve surgery
In combined coronary and aortic valve surgery, the aortic valve is replaced with an artificial valve during a bypass operation.
Heart
  • Heart transplant
In a heart transplant, the heart of a deceased organ donor is implanted into another person.
Pancreas In a pancreas transplant, the pancreas of a deceased organ donor is implanted into another person. If a kidney is also transplanted at the same time (pancreas-kidney transplant), both organs are taken from the same donor.
Liver
  • Living donor liver transplant
In a living donor liver transplant, a piece of liver is donated by a healthy adult. The donor's liver grows back to nearly its original size within a few weeks of the operation.
Liver
  • Liver transplant
In a liver transplant, the healthy liver of a deceased organ donor is implanted into a person who has liver disease.
Gallbladder
  • Cholecystectomy
Cholecystectomy is the name of the surgical removal of the gallbladder – which may be used to treat gallstones causing frequent pain and colic or if there is a risk of jaundice or cholangitis (infection of the bile duct).
Kidney
  • Living donor kidney transplant
In a living donor kidney transplant, a healthy person donates one of their two kidneys. After the operation to remove the organ, the remaining kidney does all of the work that the kidneys previously did together.
Kidney
  • Kidney transplant
In a kidney transplant, a healthy kidney is implanted into a person who has kidney disease. The kidney may come from either a living or deceased donor.
Female sex organs
  • Gynecological surgery
Gynecological surgery includes various forms of surgery performed on the ovaries, fallopian tubes, uterus (womb) or vagina.
Pregnancy
  • Obstetrics
Obstetrics includes all of the tests and treatments for the mother and child shortly before, during and after the birth. The birth itself and initial care in the hours following the birth are also part of obstetrics.
Pregnancy
  • Neonatology
Neonatology is the specialized care and treatment of newborn babies.
Hips
  • Hip fracture
A hip fracture is a break at the top of the thigh bone (femur). The fracture most commonly occurs very close to the hip.
Hips

Hip endoprosthesis:

  • Initial implantation
  • Replacement of prosthesis or components
Following the initial implantation of an artificial hip joint (hip endoprosthesis), the individual parts of the artificial joint (the components) may become loose, inflamed, or no longer function properly after some time. Then, either some of the parts (component replacement) or the entire artificial joint (prosthesis replacement) are replaced.
Knee 

Total knee endoprosthesis:

  • Initial implantation
  • Replacement of prosthesis or components
Following the initial implantation of an artificial knee joint (knee endoprosthesis), the individual parts of the artificial joint (the components) may become loose, inflamed, or no longer function properly after some time. Then, either some of the parts (component replacement) or the entire artificial joint (prosthesis replacement) are replaced.
Nursing care
  • Measures to prevent pressure sores
Pressure sores (decubitus) are caused by constant pressure on tissue or a part of the body – most often resulting from lying or sitting for a long time, as happens to people who are bedridden. Measures to prevent pressure sores include repositioning the patient regularly or using aids such as special cushions or mattresses.
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