Post on 03-Feb-2021
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 1
Huland Kopenhagen 2018
Systematic, standardized outcome measurementfor clinical science and quality control
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 2
>10% of all RP in Germany
Open
DV
Martini-Klinik
Radical Prostatectomy
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2200
2400
Foundation M-K
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 3
Number RP/year
2012 Median 84,0
2013 Median 78,0
2014 Median 89,5
Mayo Clinic
Johns Hopkins
60 % GKV
Martini- Klinik
Radical Prostatectomy/year
Prostate Cancer Centers Germany
4
Martini-KlinikPatient satisfaction
Would you recommend the hospital to friends or family?
10080 900
98,89Martini-Klinik Station 4
89,66
89,22
99,55
89,66
88,46
90,5691,3091,46
84,6284,6284,65
87,50
85,00
82,14
85,00
82,81
83,98
85,58
84,38
82,86
81,94
83,65
85,76
86,0586,19
83,00
85,94
82,61
UKE Mean
82,69
83,00
86,23
79,7380,00
81,25
Martini-Klinik Station 1
73,48
Martini-Klinik Station 3
89,23
100,00
76,92
79,1778,83
Source: Patient Satisfaction Survey University Hospital Hamburg-Eppendorf
5
1.Specialized on Prostate Cancer2005 founded at the University Hospital Hamburg-Eppendorf
• Diagnostic: PCa early detection/ all types of imaging: US, MRT• Local therapy: open RP .+ robot ass.RP., RTx, HDR-, LDR- Brachy- therapy
– focal therapy, immuno therapy, AS• Therapy of metastatic/cr. PC• Clinical, basic science research• Psychooncology, life style-complementary medicine
Integrated Practice Unit = IPU
Martini-Klinik
6
2.Faculty System11 tenured positions
Prof. Dr. GraefenProf. Dr. HaeseProf. Dr. HeinzerProf. Dr. HulandDr. MichlPD Dr. SalomonProf. Dr. SchlommProf. Dr. SteuberDr. ThederanProf. Dr.TilkiPD Dr. Budäus
All have their dedicated fields of prostate cancer reserach
Each patient has only one contact person „his doctor“
All are high volume surgeons - all doing 200-300 RP pro year
Martini-Klinik
7
3. Martini-Database since 1992
Martini-Database
Database-Problems
Database-Supporter
• Prostate Carcinoma Database since 1992• Profound preop. data from each patient and his tumor
(risk classification)• Outcome-Data from 22.956 Pat. after RP (Jan. 2017)
• No money: not from the administration or grants• No IT -System• No motivation of the staff• Critic of the referring urologists
Martini-Klinik
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 8
▪ Prostate Cancer Database since 1992
▪ PROM = Patient Reported Outcome Measurement
Martini-Database
Most of our recent patients online
9Martini-Database
PROM = Patient Reported Outcome Measurement
• 1week after catheter ex • early continence• 4 questions
• 6 moths post op • Grad3/4 Clavien Dindo • Complications
• Yearly for 10 years • 26 validated questions– EPIC 26
• Functional Outcome– Bladder function – Bowel function– Erectile function– Hormone Therapy
• Yearly, lifelong • 7 questions • Oncologic Outcome
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 10
69 94 80 120133192211319381485538561673791
1024133615581757
1976212221422079210222062321
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
22000
Pa
tie
nte
na
nza
hl
OP year
RP'sper year
RP's: n=25272BCR: n=4404Metastases: n=985Other Cause Mort.: n=1266PCa Mortality: n=321
Pat. Withcomplete follow-up
75.5%
> 22 956 pts. have contributed so far relevant data
Martini-Database
Pat. withfollow up
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 11
approx. 1,400 questionnaires / month
Outcome study group: 2 Database manager1 IT expert1 Biostatician
An investment is necessary
Martini-Database
12Database Outcome measurement
Clinical research
Pat. information/counselling
Valu - based Health Care
Quality control
Basic science
3
2
1
4
5
13Database has contributed to high scientific output
86
70
63
46
4037
42
32
18
0
10
20
30
40
50
60
70
80
90
100
2008 2009 20152007 20112006 2010 20142012
year
Number of publications / year
2005 2013
40
58
300 – 400Impact f. points / year
14Basic science: ICGC, TCGA
15Basic science: ICGC, TCGA
Hamburg TMA plus DatabaseSamples of 18 000 RP Pat. and their Outcome Data
Study cohort on TMABiochemical relapse
among categories
(n=11152) (n=1824)
Follow-up (mo)
Mean 53.4 -
Median 36.8 -
Age (y)
70 1439 232
Pretreatment PSA (ng(ml)
20 720 309
pT category (AJCC 2002)
pT2 7370 570
pT3a 2409 587
pT3b 1262 618
pT4 63 49
Gleason grade
≤3+3 2859 193
3+4 1565 573
4+3 6183 849
≥4+4 482 208
pN category
pN0 6117 1126
pN+ 561 291
Surgical margin
negative 8984 1146
positive 1970 642
No. of patients (%)
a) b)
c)
d)
e)
12 000 Prostate Carcinoma
600 normal Prostate tissue
180 normal Prostate
(Cystoprostatectomy)
16
BCR-free survival Cancer-specific survival
pT-stage10 year
cancer-specific survival
pT2 98,0%
pT3a 96,0%
pT3b 85,0%
pT4 72,0%
pT-stage 10 year BCR-free
pT2 87,0%
pT3a 53,0%
pT3b 28,5%
pT4 9,4%
Patient counselling
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 17
0%
20%
40%
60%
80%
100%
Alt
er
zu
r O
P
18
100,096,4
98,595,6
98,5100,099,094,6
99,199,0
6,310,7
14,9
2,2
10,4
3,28,67,55,64,8
0%
20%
40%
60%
80%
100%
Surgeon954 6 10872 31
R1
Nerversparing (NE) and positive margin (R1) pT2 PCa
Δ-0.5 Δ-2.1 Δ-2.4 Δ+4.6 Δ-2.0 Δ+6.3 Δ-0.2 Δ+2.4 Δ+0.2 Δ-2.1
NE
R1
Internal quality control of all surgeons every 6 months
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 19
PSA recurrence free survival – pT2
Surgeon
Internal quality control of all surgeons every 6 months
20
One week letter:Continence 1 week after removing the catheter
0%
20%
40%
60%
80%
100%
1095 8762 Surgeon
Vorlagen
≥4 2/3 0/1pads
421 3
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 21
*Individuel adapted, intraprostatic
apex preparation
71% Continence after1 week. Identical postive margin rate
13.7% / 14.2% (pT2-4 )
Lee et al. Urology 2006
Internal quality control every 6 months
22
789679
562
21451983
1032
547486382320
15421759
1336
0
20
40
60
80
100
2006 201020092008200720052004200320022001 201120001999
Frequency of continence (%)
Year
Significantly improving continence rates over time
An
nu
al N
o. r
adic
al p
rost
atec
tom
ies
20062000
1998
1992
2005 2008
Average continence1 year after RP, Germany
Surgeon
23
Variations in outcome -national and international
1yr severe erectile dysfunction1 yr full continence 1yr severe urinary incontinence
Ø
56,7 %
Ø
75,5 %
Ø
80,0 %
Ø
50,0 %
Ø
4,5 %
Ø
10,0 %
34,7 %
93,5 %
0,4 %
1. Swedish data rough estimates from graphsSource: National quality report for the year of diagnosis 2012 from the National Prostate Cancer Register (NPCR) Sweden, Martini Klinik, BARMER GEK Report Krankenhaus 2012, Patient-reported outcomes (EORTC-PSM), 1 year after treatment, 2010
http://upload.wikimedia.org/wikipedia/commons/b/ba/Flag_of_Germany.svghttp://upload.wikimedia.org/wikipedia/commons/b/ba/Flag_of_Germany.svghttp://upload.wikimedia.org/wikipedia/commons/4/4c/Flag_of_Sweden.svghttp://upload.wikimedia.org/wikipedia/commons/4/4c/Flag_of_Sweden.svghttp://upload.wikimedia.org/wikipedia/commons/b/ba/Flag_of_Germany.svghttp://upload.wikimedia.org/wikipedia/commons/4/4c/Flag_of_Sweden.svg
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 24
Some examples (ICHOM)
variation in 30-day mortality rate from heart attack in US
variation in bypass surgery mortality in the UK
variation in complication rates from radical prostatectomies in the Netherlands
variation in reoperation rates after hip surgery in Germany
variation in mortality after colon cancer surgery in Sweden
9x
18x
20x
Source: International Consortium for Health Outcomes Measurement
2x
4x
Variation in outcome: best/worst
http://upload.wikimedia.org/wikipedia/commons/2/20/Flag_of_the_Netherlands.svghttp://upload.wikimedia.org/wikipedia/commons/a/ae/Flag_of_the_United_Kingdom.svghttp://upload.wikimedia.org/wikipedia/commons/2/20/Flag_of_the_Netherlands.svghttp://upload.wikimedia.org/wikipedia/commons/b/ba/Flag_of_Germany.svghttp://upload.wikimedia.org/wikipedia/commons/4/4c/Flag_of_Sweden.svg
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 25
Traditional instruments for quality control and certification in health care
Process / management control
Certification, audits, quality report
Minimal surgical volume regulation
Regionalisation
No Outcome
Variation in outcome
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 26
low vs. high surgeon volume (> 40 RRPs/ year)
Transfusion rate OR 8,6
Perioperative complications, p < 0.001
numbers of LN : p < 0,009
Positive surgical margins: p < 0.001
Biochemical recurrence: p < 0.001
Risk of adjuvant therapy: p < 0.001)
Late urinary complications : p < 0.001
Potency- and Continence after 1 year: p < 0.005
Surgeon volume and
outcome
High volume
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 27
Value =
Cost of delivering those outcomes
Patient health outcomesachieved
Outcome measurements are the powerful lever to unlock a
value-based healthcare system
“Stern” Interview- März 2013: Es ist unethisch, keine Outcome Messungen zu haben
Redefining Healthcare; M. E. Porter & E. O. Teisberg 2006
Value-based Healthcare (VBHC)
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 28
International Consortium of Health Outcomes Measurement
Value-based Healthcare (VBHC)
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 29
Value-based Healthcare System:
ICHOM-Standard Set for most diseases
Systematic,
standardised ,
risk adapted ,
transparent,
international comparable
Outcome-analysís by the use of PROM
Minimal Data Set per disease:
Only outcome data-which matters for the patients
Value-based Healthcare (VBHC)
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 30
ICHOM’s first Standard Sets
What should be documented before and after treatment ?
A minimal Standard Set for cross disciplinary Outcome Measurement - identical for all treatment options including AS
Value-based Healthcare (VBHC)
31
March 2013Invitation to experts to jointhe working groupby H.Huland / M.Graefen
Mai 2013Meeting of the working group at the AUA,San Diego
Mai-Dec. 20136 Telephone conferences,multiple surveysof the working group
Nov. 2013 Manual Loc. Prostate Cancer2nd ICHOM conference ,Harvard Boston
Prostate Cancer Working Group: 28 Pers. 9 countries: Urology, Radiotherapy, Exp. nat. Registries , Pat. Represent.
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 32
PCO-CRV Leadership Team
Prostate Cancer Outcomes-Compare And Reduce Variation PCO-CRV Trial
C . M O O R E S . E V A N SH . H U L A N DM . L I T W I NJ . M I L L A R J . L E W I S
• To describe international patterns of presentation, care, and patient-reported outcomes for men diagnosed with localized prostate cancer.
• To provide feedback on quality metrics and outcomes; thereby identifying organisations with better and worse outcomes and to identify contributing structure and process factors.
M O V E M B E R
P. V I L A N T I
I N T E R N A T I O N A L S T U D Y S I T E S : 1 4 0 I N S T . 1 4 C O U N T R I E S
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 33
I n t e r n a t i o n a l s t u d y s i t e s : 1 4 0 I n s t . 1 4 C o u n t r i e s
Prostate Cancer Outcomes-Compare And Reduce Variation
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 34
Outcome Measurement
with transparent results
Requires an investment, but it pays off
It is intellectual fun
Enables medical progress
Improves Quality
Reduce overall costs
Can be the basis for a great success for the clinic
We should do it for our patients
Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 35Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 36Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 37Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 38
Prostate Cancer Outcome (PCO) Study
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 39Value-based Healthcare (VBHC)
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 402017 – standard sets for 50%
of the world wide diseases
201
7
50%
201
6
46%
201
5
40%
201
4
29%
201
3
14%
Krankheitslast in
Industrienationen
4
Krankheitsbilder
2013 2014 2015 2016 2017
12
Krankheitsbilder
24
Krankheitsbilder 40
Krankheitsbilder
50+
Krankheitsbilder
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 41
With a vision of systematically measuring clinical and patient outcomes for men with
localised disease, comparing health outcomes, sharing results and mobilising the exchange of knowledge in a global population, PCO-CRVs Study Objectives
are:
Prostate Cancer Outcomes-Compare And Reduce Variation PCO-CRV Trial
42
Theodor Billroth, 1860
Quote by a visionary German surgeon 150 years ago
Soon, there will be a time where our scholars and colleagues will not be satisfied with general comments
on surgical quality outcome-instead they will call any physician a charlatan who is
incapable to quantify his results.
““
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 43Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 44
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 45
▪ > 5,000 Prostata(cancer?) Patienten
▪ > 1,500 Prostata Biopsien (MRI-Fusion/konv./ Elastographie)
▪ > 2,400 Radicale Prostatektomien
▪ > 400 primäre Bestrahlung
▪ klinische Studien (> 700 Patienten rekrutiert)
▪ Wiss. Output (2015: 87 Publikationen, 560 Impact Punkte)
EIN Jahr in der Martini-Klinik
Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 46
Vickers, JNCI 2007
Individuelle Lernkurve
High volume
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 47
Neurovascular Structure Adjacent Frozen-Section Examination
positive margins =
no nerve sparing
negative margins =
nerve sparing
NeuroSAFE
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 48
StagingNerve
Preservation
Positive
Surgical
Margins
pT2 99 / 92 7 / 12
pT3a 94 / 72 21 / 32
pT3b 88 / 40 47 / 51
NeuroSAFE 97 %
Control 81 %
79,8%
Impact on nerve preservation
Nerve preservation
all stages
Schlomm, Eur Urol 2012
Nerve preservation in:
- 25.561 cases in germany 2012: 32.8 %
- 18.355 AOK-Patients 2008-2011
treated in 245 hospitals with
> 30 cases per year 37.8 %
- Barmer GEK Report 2012: 47.4 %
NeuroSAFE
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 49
Quelle *3: BARMER GEK Krankenhaus Bericht 2012
Quelle *4: Martini-Klinik Datenbank
Outcome
600
Martini-Klinik 2013
n = 2147
88.2 %
4.2 %
7.6 %
NeuroSAFE Reduces
Radiation Therapy
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 50Anteil Martini-Klinik /
Prostatektomien in Deutschland
10000
11000
12000
13000
14000
15000
16000
17000
18000
19000
20000
21000
22000
23000
24000
25000
26000
27000
28000
29000
30000
31000
32000
33000
34000
0,00
1,00
2,00
3,00
4,00
5,00
6,00
7,00
8,00
9,00
10,00
11,00
12,00
13,00
14,00
15,00
16,00
17,00
2005 2006 2007 2008 2009 2010 2011 2012
RRP in Deutschland / Anteil MKMarktanteil
Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 51
Vorteile auch für die Kern-Urologie
1. Ein Oberarzt der Urologie rotiert für mind.1-2Jahre
in die Martini-Klinik mit ca 200 RP /Jahr
2. 1 bis 2 Assistenten der Urologie rotieren ca1-Jahr
in die MK mit intensiver klinischer und wissensch.
Ausbildung (1bis 2 Jahre Facharzt Anerkennung)
3. Gemeinsame Projekte: Kongresse,
Fortbildung, Forschungsprojekte, Drittmittel ,
Vorträge , Publikationen, Auslandsjahr der Ass.
ect.
4. Gewinnabführung an das UKE
Martini-Prinzip
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 52
Die chirurgisch-onkologischen Ergebnisse verbessern sich mit steigender Opeartionszahl
Source: Vickers et al., J Natl Cancer Inst 2007; 99: 1171–1177
23
50–
99
18
29
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 53Martini-Klinik Patients Travel!
73 72 69 6962 58 59 56 56
15 13 15 1519
21 18 20 19
8 11 11 10 13 14 14 15 17
3 3 3 4 4 5 5 6 61 2 2 2 2 2 3 3 3
0%
20%
40%
60%
80%
100%
2005 2006 2007 2008 2009 2010 2011 2012 2013
Hamburg Region Within 300 Km 300 - 600 Km 600 - 900 Km International
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 5409/2017 Additional Ward
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 552020 New Martini-Klinik
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 56
Some ideas to establish general
Outcome Measurement in health care systems
OM results for:
- Certification for Centers - Reimbursement for treatments
e.g. not the number of cases but quality counts
OM results transparently reported e.g. on websites of :
- patients
- physicians
- health insurance companies
- hospitals
57
2.2132.1022.0792.1422.1221.9761.7571.5561.3361.024791673561538485381211
8094690
1.000
2.0003.0004.0005.000
6.0007.0008.000
9.00010.00011.00012.000
13.00014.00015.000
16.00017.00018.00019.000
98.6
1997 19981994
98.4
19931992
99.098.298.699.3
1996 2006
95.6
2003
96.9
2005
95.7
97.9
2000
98.2
1999
95.2
2001 2004 2007
95.3
95.8
2002
97.8
98.4
2008
Patient number
1995
99.0
89.6
2012 2013
93.4
20112009
94.9
2014
83.7
2015
91.9
94.1
2010
94.6
319
OP year
120 192133
23.000 patients have contributed so far relevant data to Martini database
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015189.2 181 192.8 178.3 179.2 180.4 170.2 156.7 144.7 144 132.1 120.4 108.7 96.7 84.9 80.7 72 60 48.1 36.2 24.8 13.6 8.9 1.4
Dat
abas
e-
Sup
po
rte
r
RP's / year
% patient with follow-up information per year
Database: RP (total n= 22 956) high follow-up rate (75.5%)
58
Each faculty member has a dedicated field of supra-specialization in prostate cancer
• (Study Outcome Group, Robotic Surgery)Prof. M. Graefen
Prof. H. Heinzer
Prof. H. Huland
Prof. A. Haese
Prof. T. Steuber
Prof. T. Schlomm
PD Dr. G. Salomon
Dr. U. Michl
Dr. I. Thederan
PD Dr. L. Budäus
Prof. Dr. D. Tilki
• (Resident Education, Events)
• (International Outcome Standardization)
• (Robotic Surgery, Serum/Urine Marker)
• (Advanced PCa)
• (Basic Science, Genom Analysis)
• (Focal Therapy, Imaging)
• (QoL, Functional Data)
• (Complementary Medicine, Nutrition)
• (Imaging)
• (Clinical Science , International Cooperations)
59Martini-Klinik
Associated Faculty
• AnästhesiologyDr. von Breunig
Prof.Dr. Sauter
Dr. Schwarz
PD.Dr. Beyersdorff
Dr. Krüger,
Dr. Schöllermann
• Pathology
• Radiation Therapy
• Radiology
• Psychooncology
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 60Top 10 academic PCa center 2015
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 61
Laborjournal 7/8 2012
„...most cited
German speaking
Urologists.“
Database Outcome measurement
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 62
Continence (%) 1 year after RP
Surgeon
Significantly improving continence rates over time
9
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 63
0
10
20
30
40
50
60
70
80
90
100
%
R1 pT2 aktuell
R1 pT2 zuvor
NE pT2 aktuell
NE pT2 zuvor
pT2 Tumor
Δ+0.5
Δ+2.1
Δ-2.4
Δ+4.6
Δ+2.0
Δ+6.3
Δ+0.2
Δ+2.4
Surgeon
Nerversparing (NE) and positive margin (R1)
current - before -
1 2 3 4 5 6 7 8
Internal quality control every 6 months
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 64
More than 50% of all RP in Germany were done in hospitalwith less 50 RP per year
0
500
1000
1500
2000
2500
1 9
17
25
33
41
49
57
65
73
81
89
97
10
5
11
3
12
1
12
9
13
7
14
5
15
3
16
1
16
9
17
7
18
5
19
3
20
1
20
9
21
7
22
5
23
3
24
1
24
9
25
7
26
5
27
3
28
1
28
9
29
7
30
5
31
3
32
1
32
9
33
7
34
5
35
3
36
1
36
9
37
7
38
5
39
3
# hospitals
# prostaectomies per year
High/low volume
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 65
low vs. high hospital volume(> 54-141 RRPs/ year)
30 day mortality : RR 1.51
Blood transfusion : p < 0.001
Intraoperative complications : p < 0.01
Postoperative complications : p < 0.001
Late urinary complications : p < 0.001
risk of adjuvant therapy : p < 0.001
IMC : low: 19%, high: 1.3%, p < 0.001
High volume
66
789679
562547486
382320
230195142120819469
18
364
686
1.500
500
1.000
0
2.500
2.000
2004 20072002 20112010200820032001200019991996 1998 200919971992
151
1.973
225
1.755
19941993 1995
RP in HH/Martini-Klinik, 1991-2011 n=14682
20062005
1.335
1.541
2.225
1.024
DaVinciTotal Number Nerve-sparing
Patient counselling
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 67
▪ Revision < 0.2 %
▪ Colon/ureter injury < 0.2 %
▪ death 0 %
▪ blood transfusion < 5 %
▪ MRSA < 0.1 %
Internal quality control every 6 months
Prof. Hartwig Huland Qualitätskontrolle und Fortschritt Nr. 68Measure what you are Doing!Internal quality control every 6 months