title: Adverse outcomes in surgical patients: implementation of a nationwide reporting system.
abstract: OBJECTIVE
  Lack of comparable data on adverse outcomes in hospitalised surgical patients.
  
  
  METHODS
  A Plan-Do-Study-Act (PDSA) cycle to implement and evaluate nationwide uniform reporting of adverse outcomes in surgical patients. Evaluation was done within the Reach Efficacy-Adoption Implementation Maintenance (RE-AIM) framework.
  
  
  METHODS
  All 109 surgical departments in The Netherlands.
  
  
  METHODS
  Increase in the number of departments implementing the reporting system and exporting data to the national database.
  
  
  METHODS
  The intervention included (1) a coordinator who could mediate in case of problems; (2) participation of an opinion leader; (3) a predefined plan of action communicated to all departments (including feedback of results during implementation); (4) connection with existing hospital databases; (5) provision of software and a helpdesk; and (6) an instrument based on nationwide standards.
  
  
  RESULTS
  Implementation increased from 18% to 34% in 1.5 years. The main reason for not implementing the system was that the Information Computer Technology (ICT) department did not link data with the hospital information system (lack of time, finances, low priority). Only 5% of the departments exported data to the national database. Export of data was hindered mainly by slow implementation of the reporting system (so that departments did not have data to export) and by concerns regarding data quality and public availability of data from individual hospitals.
  
  
  CONCLUSIONS
  Hospitals need incentives to realise implementation. Important factors are financial support, sufficient manpower, adequate ICT linkage of data, and clarity with respect to public availability of data.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Centre, The Netherlands. p.j.marang@lumc.nl
authors.forename: P J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
authors.forename: M C
authors.initials: MC
authors.lastname: Stadlander
authors.forename: J
authors.initials: J
authors.lastname: Kievit
mesh_terms: D019985:Benchmarking; D003628:Database Management Systems; D016208:Databases, Factual; D006284:Health Plan Implementation; D006801:Humans; D009313:National Health Programs; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012308:Risk Management; D012984:Software; D013503:Surgery Department, Hospital / Q000592:standards*; D011795:Surveys and Questionnaires; D018511:Systems Integration