Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

National Quality Assurance and Improvement System

National Quality Assurance and Improvement System (NQAIS), delivered by the Health Intelligence Unit in the HSE in collaboration with the NCPS.

NQAIS Medicine and NQAIS Surgery were developed to support a continuous quality improvement approach to the management and delivery of clinical care to patients in HSE-funded hospitals. Both tools are tuned to support the identification of Average Length Of Stay (AvLOS) variance in the delivery of equivalent healthcare services to patients between hospitals and teams. As part of quality improvement projects, teams can learn how they are performing relative to other teams and can incorporate methods, processes and approaches used in top quartile teams into their healthcare approach. NQAIS Medicine and NQAIS Surgery are design to support the adoption of the Models of Care developed by the relevant national programmes.

NQAIS Surgery

NQAIS Surgery was release in 2014 and is an online reporting tool which analyses HIPE data for patients discharged following a surgical operation as the primary procedure during their episode of care. The tool has been designed to aggregate and present metrics for day case rates (% DC), inpatient AvLOS and inpatient day of surgery admission rates (% DoSA). These metrics are dynamically available at surgical specialty and procedure level with supporting metrics and graphical representations of the metrics and their trending over time. Further predictive values are provided to illustrate how the hospitals metrics would change if they were to achieve performance levels of the top performing surgical teams in Ireland or where set by the national clinical leads, a comparison against international best practice.

These predictive metrics indicate the number of bed days that would have been saved or the number of additional cases that could have been performed if the relevant hospital’s surgical team were delivering in the top quartile for average length of stay for inpatients and day case rate.

NQAIS Medicine

NQAIS Medicine was released for use in June 2016 and has evolved the concept seen in NQAIS Surgery and reviews data in the context of primary diagnosis or reason for admission to hospital. It reviews clinical activity in the context of 'best peer practice' AvLOS targets by diagnosis. The objective metrics in NQAIS Medicine are provided as an aid to clinicians, clinical directors, and hospital management who need to review workload and bed requirements. These metrics are dynamically available at hospital, specialty, clinical team and diagnosis level in numeric and graphical format for selectable time periods and their trending over time. Predictive values are provided to illustrate how the hospital metrics would change if they were to reach the AvLOS targets of the top achieving AMP teams in Ireland or where set by the AMP. These predictive metrics indicate the number of bed days that would have been “saved” or the number of “additional cases” that could have been admitted if the hospital’s throughput was delivering in the top quartile (target) for AvLOS – i.e. the opportunity loss from missing the target. NQAIS Medicine may be used by surgeons and other clinicians to review their patients discharges from a diagnostic perspective (reason for admission to hospital) and can differentiate between those patients who had surgery during their stay in hospital and those who did not.

Both tool contain dynamic controls that allow the user to ‘filter’ the data they are looking at, zooming in on specific areas of interest in support of QI investigation.

NQAIS Medicine and NQAIS Surgery are made available to clinicians and managers in all HSE-funded hospitals, who sign up to use the reporting tool, agree to adhere to HSE data confidentiality and information policies, and have the authorisation of the hospital senior management to use that hospital’s data and reports. Both systems have been designed collaboratvely by the National Clinical Programmes and the Health Intelligence Unit, Health & Wellbeing, HSE, developed and supported by OpenApp, and is deployed under the governance framework of the national clinical programmes in adult medicine and surgery.

Data sources

The hospital inpatient enquiry (HIPE) system is a health information system designed to collect medical and administrative data regarding inpatient and day case discharges from, and deaths in, acute public hospitals.

Each HIPE discharge record represents one episode of care following admission to the given hospital for an individual patient, recording demographic, administrative, diagnoses, procedures and other related data. Discharges are coded using ICD-10-AM / ACHI, (the Australian Modification of ICD-10 incorporating the Australian Classification of Health Interventions) 8th Edition.

HIPE is managed by the Healthcare Pricing Office and further information on HIPE can be found at hpo.ie