Quality indicators are numerical measures, such as percentages or rates, that indicate the quality and safety of processes, organisation, and healthcare performance. Quality indicators should be subject to the criteria set out in the regulation on quality indicators (Icelandic).
Quality indicators are one of the four critical components of the Quality Development Plan, which guides practice in healthcare provision.
The health service is evaluated with quality indicators
Quality indicators aim to monitor the quality and safety of healthcare and encourage these aspects to be visible so that the services can be assessed. Quality indicators can be used for internal and external monitoring to determine if the quality and safety of the service is following recognised professional standards and criteria.
Furthermore, quality indicators can increase quality awareness and thus contribute to improvements within healthcare.
Presentation of quality indicators
Quality indicators should be accessible to everyone so that the quality and safety of the service can be assessed and healthcare providers can work towards continuous improvement of their activities.
Quality indicators are commonly published on healthcare provider websites.
Questions for healthcare providers regarding quality indicators
Have indicators been published on the quality and safety of healthcare?
Have the results been used for improvements?
Examples of quality indicators in healthcare
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Examples of general quality indicators
Results of service surveys among users
Waiting time (for example delays in discharge, waiting lists for certain surgical procedures, waiting time for treatment)
Activity statistics (number of admissions, number of discharges, average length of stay)
Number of incidents
Staffing and composition of staff
Factors related to staff, such as staff turnover, sickness rate, and injection accidents
Safety rules – in place and followed
Frequency of falls
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InterRAI quality indicators are used to monitor and develop the quality of care in nursing homes. Examples of interRAI quality indicators are; Prevalence of falls, depressive symptoms, urinary tract infections, weight loss, daily body restraints/safety equipment, little or no activity, and pressure ulcers.
Certain standardized quality indicators exist that take into account the conditions in Iceland and are based on scientific knowledge. The Directorate of Health recommends the use of these indicators to monitor the quality of the services and to improve it. See more: InterRAI quality indicator.
Pharmaceutical quality indicators in nursing homes are used for internal and external monitoring and improvements. Pharmaceutical quality indicators concern the safety of the medication, the usefulness of the pharmaceuticals, the overall use of certain pharmaceuticals, and the cost-effectiveness of treatment.
Quality criteria for certain quality indicators are shown in the table above. It shows both the upper and lower quality criteria for each quality indicator. The criteria are defined as follows:
A poor quality criterion (upper limit) describes a problem that exists regarding care and treatment. This subject needs further investigation and needs improvement.
A good quality criterion (lower limit) describes good or excellent care and treatment. Work towards maintaining this quality and if possible to improve it even further.
Quality control
In connection with the quality standards, a help document (Icelandic) has been created. Insert information from the interRAI quality indicators to see at a glance where the nursing homes stand regarding the Icelandic quality standards.
The document contains graphs for all 20 quality indicators used in Iceland. In the header of the graphs, each quality indicator is labeled with a number that is the same as in the RAI program. Some also have a star, but these are the quality indicators considered to be the best for comparing nursing homes.
There is only one quality indicator per worksheet, and its name and number are on the tab of each worksheet. Attention is drawn to the fact that the first page contains instructions for using the document.
The Directorate of Heath recommends using these criteria to monitor the quality of the service and to make improvements.
The Directorate of Health also uses these criteria to monitor the quality of services in nursing homes.
Examples of quality indicators in hospitals
Postoperative complications
Foreign objects left in operation
Blood-borne infection after surgery
Complications of anesthesia
Femoral neck fracture following surgery
Number of readmissions
Infection rate
Waiting time in hospital after hip fracture surgery (65 years and older)
Waiting time after treatment due to "stroke" ( door-to-needle time )
Perinatal mortality
Perineal trauma after birth
Number of incidents related to blood transfusion
Cardiac ischemia, incidence of death within 30 days of hospital stay
Incidence of pressure ulcers
Total nursing hours per patient/day
Failure to rescue
Forced admission to a psychiatric ward
Service survey results
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Examples of quality indicators in operating rooms outside hospitals
Availability
Waiting time after the first arrival
Waiting time from when an operation is decided until it is scheduled
Availability outside of business hours
Process
Percentage of canceled operations
Delayed discharge
Percentage of new patients
Complications
Percentage (%) of unplanned returns to the operating room on the same day of surgery
Percentage (%) of unplanned overnight stays after surgery
Percentage (%) of unplanned returns to the operating room or hospital
Percentage (%) of unplanned readmissions to the operating room or hospital
Percentage of patients with BMI outside parameters
Percentage of patients with diabetes for whom foot care supplies are assessed
Percentage of patients aged 65 years and older with a history of fall(s) who have received a fall assessment
Percentage of patients with recorded pain where pain assessment is done before treatment
See more: Journal of the American Physical Therapy Association
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Examples of quality indicators in dental healthcare
General quality indicators
Number of inhabitants per licensed dental care workers under retirement age
Number of inhabitants per practicing dental health care workers under retirement age
Number of dentists under retirement age compared to other dental care workers
Cost of dental care per inhabitant.
Process quality indicators
Percentage (%) of the population who have consulted the dental health service in one year
Tooth brushing frequency (more than once a day)
The consumption of soft drinks containing sugar
Performance quality indicators
Percentage of examined children and adolescents who are free of dental caries
Average values of caries index in children and adolescents
Sic-Measure of Caries Frequency
Percentage (%) of the edentulous population aged 65–74
Percentage (%) of people aged 65–74 years who have at least 20 teeth left in their mouth
Other quality indicators
Percentage (%) of the population that regularly consults the dental health service
Self-estimated dental health (oral health)
Self-estimated ability to chew
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Specialized day care for people with dementia is different from other health services for adults. It is provided to adults, who usually have not requested it, and often do not know the purpose of it or what it entails. Relatives and healthcare professionals usually take the initiative.
It is very common for persons with dementia to show improvement in terms of cognitive symptoms and mental well-being after treatment in specialized day training begins. However, more people benefit. Relatives get a break from responsibility, and there can be a delay in 24-hour care in a nursing home. In some cases, the day training can allow the patient's partner to stay longer in the labor market than would otherwise have been the case.
