Very complex and partially incorrect

Berlin – Doctors and hospitals express clear criticism of the Federal Hospital Atlas. According to criticism, it is not understandable to laypeople and would not help patients find the appropriate treatment for their disease. Additionally, the atlas sometimes presents incorrect data. Federal Health Minister Karl Lauterbach (SPD) promised an update with improvements.

The Federal Hospital Atlas has been online for a week. It must inform patients, but also doctors, about hospitals and inform about your services. The nearly 1,700 somatic hospitals (excluding psychosomatic and psychiatry clinics) are presented with treatment numbers for the respective disease and department, site-wide nursing staff and nurse staffing ratios, minimum quantities, emergency levels and selected certificates. An expansion is planned, among other things, in the number of doctors and midwives, as well as complication rates. The directory is maintained by the Federal Ministry of Health (BMG) operated.

The chief physician of the Thoracic Surgery Clinic at AMEOS Klinikum Schönebeck, Steffen Frese, notes that the atlas is based without filters on the international disease classification ICD 10/11 and the OPS codes and names all clinics that use the code, regardless of whether diagnosis, therapy, palliation or only as a secondary diagnosis. “This is incomprehensible to lay doctors because they cannot know what specific treatments they need,” Frese told German medical journal.

Frese complained that the OPS codes were not grouped into meaningful groups. Even he, as a specialist, could not find a suitable clinic for surgical treatment with the keyword “lung cancer”. For Magdeburg and the surrounding area, for example, 18 clinics would appear, many of which do not offer thoracic surgery, oncology or radiation oncology, criticized Frese.

In principle, the atlas could be a way to present the quality and services of care offered in psychiatric and somatic clinics in a transparent and comparable way, he emphasized. Initiatives to improve the quality of care are welcome. However, Frese considers this atlas in its current form “confusing and harmful” to patients.

Doctors don’t have time to click through complex terms

The atlas is also intended for doctors who carry out hospital admissions. General practitioner Nicolas Kahl from Nuremberg complained that the Federal Hospital Atlas does not present operations and treatments in a language that laypeople can understand, but rather in complex terms. “Additionally, treatments that are done frequently are not shown above. This shows that the user perspective is not at the forefront,” Kahl told dem German medical journal. “I also did not find any clinic in the atlas with a large number of operations in our region.”

Family doctor Kahl does not have time to go through the various complex and individual procedures or diagnoses, in his opinion, it should be better structured; “If the atlas does not provide reliable results, I cannot recommend it to my patients. The way the directory is currently structured, it does not offer any added value. “The whitelist was more usable,” Kahl said.

The German Hospital Society (DKG) warns about the use of the Federal Hospital Atlas. “Unfortunately, the Lauterbach hospital atlas does not come close to delivering on its promise to create more transparency in hospital treatment,” said DKG Vice President Henriette Neumeyer. “On the contrary, numerous incorrect and missing data greatly mislead patients.” At this time, the DKG should advise those seeking information to treat the atlas with the utmost caution, to consult the treating physicians, and to use a proven platform to obtain information. fall back. “We ask the Federal Ministry of Health to correct the errors as quickly as possible and provide the atlas with a reference to the errors that still need to be corrected,” Neumeyer said.

For the Gehrden location of the KRH Siloah and Gehrden clinics, for example, the atlas indicates a case number four for radical prostatectomies. The DKG explains that the number of cases is actually 156. If a layman searches with related search terms, the hospital does not even appear in the results list, despite its specialization. “Clinic Atlas transforms a specialized clinic with numerous quality features into a clinic with punctual service.”

Lauterbach promises updates and bug fixes

Federal Health Minister Karl Lauterbach (SPD) said at a press conference today: “We are aware of the deficiencies.” He announced that the atlas would be updated today and that most of the problems would then be fixed. A set of data was exchanged that summarized some procedures and evaluated some clinics in a misleading way, the Federal Ministry of Health (BMG) added when requested.

“There was some outdated information in the Federal Hospital Atlas, especially because reports from clinics arrive later. We have also re-optimized the search function, there are some points that need to be improved,” said Lauterbach today. BMG explained that some clinics also provided incorrect information in quality reports or in the hospital directory. “Only a dozen clinics complied with the April request to update their own information in the national hospital directory. The amended reports will be incorporated immediately,” said a ministry spokesperson.

As with any major IT project, there are teething problems in the early days, Lauterbach emphasized. In principle, the Atlas of Federal Hospitals provides information that is not available anywhere else with this level of detail. And the clinical atlas will continue to improve as a learning system, the minister promised. BMG added that any need for corrections can also be reported via the contact form.

Craft mistakes

The Association of Senior Hospital Doctors (VLK) indicates major craftsmanship errors. “Figures taken from routine data from various institutes often have little in common with reality and are not plausible,” explained the VLK. For example, in maximum care providers, the number of cases of coronary heart disease – one of the most common diagnoses in cardiology – is given as four to five, although several hundred or more than a thousand have been given. There are also large obstetric clinics that, according to the atlas, do not perform cesarean sections. “We can only be surprised by this, especially in a matter that has had external and transparent quality assurance for everyone for decades”, writes the association.

“You just can’t put a version like that online. In this situation, patients seeking valid information can only be informed that the DKG and hospital directory were established and validated more than two decades ago. DKTIG “to use,” said Michael Weber, president of the VLK.

Hospitals also demonstrated. The Niels Stensen Clinics, the Christian Children’s Hospital Osnabrück and the Osnabrück Clinic criticize that the Federal Hospital Atlas contains incorrect data and therefore distorts the comparison of clinics.

For example, case numbers in individual departments of the Niels Stensen Clinics, such as the number of births or the number of artificial knee joints used, are out of date. An emergency care service for a hospital in the Niels Stensen network is even shown, although there is none there. “Such errors are grossly negligent and misleading,” said Werner Lullmann, managing director of the Niels Stensen Clinics. Patients would be misled in their quest for transparency with this atlas.

2022 data

At the presentation of the Federal Hospital Atlas last week, Federal Minister of Health Karl Lauterbach (SPD) and Claus-Dieter Heidecke, head of the Institute for Quality Assurance and Transparency in the Healthcare System (IQTIG) refers to the 2022 database. The delay can be explained by quality assurance data assessments, Heidecke said. However, the data must be updated this year to 2023 numbers.

The Hochsauerland Clinic also expressed criticism. Entire service areas of the clinic are not represented correctly in the atlas. There were around 10,000 treatment cases missing, that is, around a quarter of the entire range of care. This included all care services provided by the internal medicine, neurosurgery, trauma surgery and orthopedics clinics in Alt-Arnsberg until 2023 at the Hochsauerland Clinic at the Marienhospital Hospital. During the inauguration of the new emergency and intensive care center, the service offering was reallocated.

“Of course, the care offerings have not been eliminated, but are provided in full and grouped with other medical services for comprehensive emergency care at the largest Karolinen Hospital, which is equipped to the most modern standards,” said the medical director of the o hospital. Hochsauerland Clinic, Peter Lütkes. “The services are not shown in the Federal Hospital Atlas, as if the clinics were closed”, he criticized.

The Federal Hospital Atlas also neglects important aspects, he emphasized Federal Nursing Management Association. The association criticized that the purely data-based presentation completely ignores the interaction between nursing and therapeutic measures, which significantly contributes to a better outcome. The health status of patients is not taken into account, he continues. Equipment with medical technology and the degree of digitalization are also not taken into account, despite their proven effect on the quality of treatment. And: “Due to their broad scope and the greater complexity of the cases treated, university hospitals perform worse in the chosen presentation”, explains the nursing association.

“There was no possibility to verify the data in advance or test the Federal Hospital Atlas in pilot installations,” complained Sarah Lukuc, President of the Federal Nursing Management Association. This way, weaknesses could have been identified and expertise brought in. The Federal Ministry of Health’s renewed individual effort is making daily work in clinics even more difficult, Lukuc said. © cmk/aerzteblatt.de