The monitoring of indicators enables the detecting of atypical results, potential clues of care quality or safety troubles. This is the principle of a surveillance system for alerts leading professionals to analyze their results and their practices in the event of a result deviating from the expected value and to implement improvement actions when an alert is confirmed. 

 International literature search carried out by HAS showed that surveillance systems have been used in several countries for many years, can be used routinely from health databases, must trigger, when the alert threshold is reached, a self-assessment process (coupled or not to other external processes, such as peer review) and should be regularly reassessed.  

 In France, such a surveillance system for alerts has been adopted for surgery: as part of the renovation of the decrees authorizing surgical activities, the Ministry of Solidarity and Health contacted the French national Authority for Health (Haute Autorité de santé) to define, with the help of the French Technical Agency for Information on Hospital Care (ATIH), the results indicators measured from the medico-administrative database of medical activity coding for hospitalization in medicine, surgery, obstetrics and odontology (PMSI-MCO) allowing an alert in terms of quality and safety of care for surgical activities.  

For each surgical specialty, 5 to 8 indicators were selected and defined, i.e. a total of 77 indicators. These indicators related to mortality, readmissions and safety. There were 15 specialty-specific indicators and 59 “any surgery” indicators. HAS also made recommendations on the use of vigilance indicators relating to adjustments, alert thresholds, reporting frequency and format, and frequency of review. The development phase of the indicators by ATIH is underway. 


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