How to Apply - Process

Members of the Accreditation Committee are appointed by the ESES Executive Committee and approved at the ESES General Assembly. If an accreditation applicant meets the required prerequisites, ESES appointed auditors who will evaluate whether the information provided in the application is valid. This is done by a virtual on-site visit. The decision regarding rejection or acceptance of the application is made by the ESES Accreditation Committee in a transparent manner, based on fixed criteria. Thereupon, the clinic or department receives a certificate that will be valid for 5 years except for the clinics with a ‘temporary certification’ after transforming a comparable national certificate to an ESES certificate.. The certificate contains a logo that may be included in letterheads, on web pages and other communications of the clinic or department.

§1 Responsibilities

1. The Accreditation process follows the general definition of accreditation that is outlined in the European Norm EN 15224:2012 for healthcare organizations.
2. The accreditation process is carried out by the ESES office.
   Office address: ESES Vienna Office, c/o Vienna Medical Academy, Alser Str. 4, 1090 Vienna – Austria, E-mail: [email protected], Web: www.eses.cc, Phone: +43 1 405138337, ZVR: 066343015
3. The Accreditation Committee
   1. appoints members of ESES as auditors,
   2. determines requirements for accreditation, which may be changed every 3 years,
   3. determines Standard Operating Procedures for auditing,
   4. decides on acceptance or refusal of accreditation. The decision is final.
   5. will submit a decision letter to the applicant, with a summary of the audit and the decision of the Accreditation Committee.
4. Appointed auditors perform a virtual site visit following SOPs. Results of the audit performed by two auditors are documented in a standard audit form that is submitted to the Accreditation Committee.

§2 Certifiable Endocrine Surgery units

1. An individual surgical clinic or surgical department or surgical section, headed by a responsible endocrine surgeon is eligible for accreditation.
2. The ESES accreditation certificate shall be awarded to an institution as defined in section 1 in conjunction with a single dedicated surgeon responsible for Endocrine Surgery. Neither a department nor a surgeon may be certified on its own. If the endocrine surgeon named in the application leaves the institution, the certificate loses its validity.

§3 ESES Accreditation Levels

1. Depending on staffing and equipment, clinical experience, training, and scientific activities, two ESES accreditation levels are defined and for two categories:
   1. ESES Competence Centres:
      • ESES Competence Centre for neck Endocrine Surgery
      • ESES Competence Centre for Endocrine Surgery
   2. ESES Reference Centres:
      • ESES Reference Centre for neck Endocrine Surgery
      • ESES Reference Centre for Endocrine Surgery
2. In the process of implementation, ESES accreditation is at present restricted to ESES Competence Centres for Neck Endocrine Surgery and Endocrine Surgery. Criteria for ESES Reference Centres for Neck Endocrine Surgery or Endocrine Surgery will be defined in the future.
3. It is necessary to demonstrate that certain requirements are met, regarding human resources, including a qualified surgeons defined in §6, material, infrastructure, and processes needed to perform endocrine surgery under safe conditions. The unit should comply with a series of standards regarding minimum number of interventions, results, quality control, and to participate in teaching and research activities.

§4 Minimum annual number of interventions

ESES Competence centre for neck endocrine surgery and endocrine surgery should perform the following number of procedures per year:

Type of intervention	ESES Competence Centre
Benign goitre	100 (50*)
Thyroid malignancy	25 (15*)
Cervical lymph node dissection of the lateral lymph node compartments	10 (5*)
Hyperparathyroidism     pHPT     sHPT and hereditary HPT	25 (15*) 5 (3*)
Additional for Endocrine Surgery
Adrenal or Paraganglioma excision	10 (5*)
GEP-NET	12 (6*)

*) minimum number for each endocrine surgeon of the unit

§5 Outcome quality indicators

5.1. Thyroid surgery

1. Early postoperative unilateral recurrent laryngeal nerve (RLN) paresis defined as vocal cord paresis within the first week after surgery, diagnosed by post-operative laryngoscopy or documented by intraoperative neural monitoring following the International Standard Guideline Statement (clinical monitoring of voice quality is insufficient). RLN injury (early postoperative paresis) for a standard thyroidectomy should be <5% per nerves at risk with a lost to follow-up of <2%. All patients with RLN injury should be followed until normal vocal cord movement has been documented by laryngoscopy or at least until 6 months postoperatively. The rate of RLN should be reduced to less the 2% after a follow-up of 6 months. All patients with early complications should be offered a followed-up at least for 6 months with mandatory laryngoscopy. The aim is that at least 80% of the patients with nerve complications should be followed up.
2. Postoperative haemorrhage requiring re-intervention
   Post-thyroidectomy haemorrhage requiring re-intervention must be <2%.

5.2. Parathyroid surgery

1. The Rate of normalized parathyroid function following resection of sporadic primary hyperparathyroidism (pHPT, first time surgery) defined as normalized or low PTH level on the first postoperative day. The normalization rate must be ≥92%.
2. The conversion rate to bilateral surgery in patients with unilateral or focused surgery, should be < 10 %.
3. Negative neck exploration (no enlarged or only normal parathyroid glands are found) should be < 5 %

§6 Structure, Staff, Equipment and Multi-disciplinary Collaboration

6.1. Structure

Competence centres must provide:

• In-patient capacity
• Outpatient clinic: at least once a week
• Administrative and teaching rooms within the Department
• Operating theatre capacity to perform the minimum required numbers

6.2. Staff

The unit must have, at least two surgeons, dedicated to endocrine surgery, who meet requirements for specialist training, continued medical education, multi-disciplinary links, demonstrable academic and professional skill. One surgeon is the Responsible surgeon and at least one other Associate Surgeon is included in the application. All surgeons must be members of ESES and hold a specialist diploma in General or ENT Surgery. At least one of the surgeons must have passed EBSQ qualification for Neck-Endocrine Surgery, Adrenal and Neck-Endocrine Surgery or Endocrine Surgery. Either the responsible surgeon or an associate surgeon should be present either as lead or assistant for every operation. All surgeons named in the application must demonstrate their attendance at courses and related conferences (national or international), adding up to a total of at least 24 hours (e. g. 3 days with 8 hours per day). The attendance must be proved by certificates of attendance.

6.3. Equipment. Diagnostic procedures

Within the hospital infrastructure, Competence Centres in Neck Endocrine Surgery must have access to ultrasound and intraoperative neural monitoring.
All accredited centres must have the possibility to perform pre- and post-operative laryngoscopy.

6.4. Multi-disciplinary collaboration

Collaborating disciplines should be preferably located in the same hospital but cooperation with selected units outside the hospital are also accepted, but only if there is a formal service level agreement with the provider. The list below summarizes the necessary team members to provide a high-quality service:

• Anaesthesiology 
• Intensive Care Unit (ICU)
• Cardiology
• Pathology: cytology, histology, frozen section, immunohistochemical analysis
• Radiology: CT, ultrasound, intraoperative ultrasound, MRI
• Interventional radiology
• Endocrinology and/or internal medicine
• Otolaryngology
• Speech therapy
• Nuclear Medicine: scintigraphic diagnosis, investigation, and therapy
• Laboratory testing service
• Blood transfusion service with blood and its products
• Thoracic surgery
• Vascular or cardiovascular surgery
• Oncology
• Radiotherapy
• Clinical Genetics
• Endoscopic ultrasound for Endocrine surgery centres
• Access to cryopreservation of oocytes/semen

All malignant endocrine diseases should be presented and discussed in multidisciplinary tumour board meetings on a regular basis, and at least every two weeks.

§7 Research

Competence centres should participate in the following research activities:

• Oral and poster communications to national or international endocrine surgical conferences
• Local research

§9 Quality Control

At least one endocrine surgeon of the unit must be a member of the Eurocrine Society, and document operations and outcomes in the Eurocrine® database.

§10 Application Process

1. All necessary application forms and type of documents are listed on the ESES webpage (Link to webpage).
2. All documents must be sent electronically to the Accreditation Committee.
3. The accreditation committee evaluates the application. If all requirements are met, a virtual on-site visit with two auditors appointed by ESES is scheduled.
4. The virtual on-site visit follows standard procedures determined by the Accreditation Committee
5. The two auditors prepare an audit report following standard specifications and recommend acceptance or refusal of the application.
6. The audit report and the recommendation are discussed by the Accreditation Committee.
7. The application is accepted if approved by a majority of accreditation committee members.
8. The decision of the Accreditation Committee is final and cannot be appealed.
9. A summary of the audit and the decision of the Accreditation Committee will be sent to the applicant.

§ 11 Auditors

Auditors are surgeons specialised in endocrine surgery, ESES members, hold a FEBS (Neck-Endocrine Surgery, Adrenal and Neck-Endocrine Surgery or Endocrine Surgery). They should not have a conflict of interest with respect to the audit.

§12 Quality control and Auditing

ESES certification auditing is based on surgical outcomes as documented in the Eurocrine®. The correctness of data in Eurocrine must be demonstrated with a national Eurocrine data audit. The audit for ESES accreditation must be performed within 3 months after acceptance of the application. The auditors and the clinic representative agree on date and time of the audit. It is the responsibility of the clinic representative to invite cooperating partners/clinics that are named by the auditors.

§13 Certification

1. Certification is valid for 5 years except for the clinics with a ‘temporary certification’ as mentioned in §14.
2. Certification may be reduced to between one and three years if deviations of requirements are found.
3. The certificate loses its validity if core requirements of the accreditation are not met during the certification period.
4. The accreditation committee must be informed by the clinic when circumstances change, and core requirements are no longer met.
5. The responsible surgeon must inform the accreditation committee regarding changes in the department that affect the core requirements.

§14 Varia

1. Clinics or departments that hold a national accreditation in Neck-Endocrine or Endocrine Surgery may apply to transform this certificate to an ESES certificate.
2. The ESES accreditation committee evaluates if the national certification requirements correspond to the ESES certification requirements.
3. The certification period corresponds to the remaining term of the national certificate, but with a maximum of 2 years.
4. The process of the following re-certification will equal a first ESES certification.