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Adverse outcomes in surgical patients: implementation of a nationwide reporting system
  1. P J Marang-van de Mheen1,2,
  2. M C Stadlander3,
  3. J Kievit1,2,3
  1. 1Department of Medical Decision Making, Leiden University Medical Centre, The Netherlands
  2. 2Association of Surgeons of the Netherlands, Utrecht, The Netherlands
  3. 3Order of Medical Specialists, Utrecht, The Netherlands
  4. 4Department of Surgery, Leiden University Medical Centre, The Netherlands
  1. Correspondence to:
 Dr P J Marang-van de Mheen
 Department of Medical Decision Making, Leiden University Medical Centre, J10-S, P O Box 9600, 2300 RC Leiden, The Netherlands; p.j.marang{at}


Problem: Lack of comparable data on adverse outcomes in hospitalised surgical patients.

Design: 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.

Setting: All 109 surgical departments in The Netherlands.

Key measures for improvement: Increase in the number of departments implementing the reporting system and exporting data to the national database.

Strategies for change: 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.

Effects of change: 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.

Lessons learned: 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.

  • adverse outcomes
  • reporting
  • surgery

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  • The data were collected as part of a project funded by the Health Research and Development Council (grant number 16450001) and by the Association of Surgeons of The Netherlands. The development of the nationwide system including the software and related technical support is funded by the Order of Medical Specialists.

  • Conflict of interest: none.