Will the lead clinician please stand up?: We should be promoting total quality care

doi:10.1136/bmj.330.7497.966-c

BMJ 2005;330:966 (23 April), doi:10.1136/bmj.330.7497.966-c

Letter

Will the lead clinician please stand up?

We should be promoting total quality care

The first 150 words of the full text of this article appear below.

EDITOR—Godlee's comment about the fragmented care describedby Gannon in his personal view prompts us to provide additionalevidence from our study at a district general hospital.^1
2 Aspart of a research project we persuaded clinical teams to examinethe quality of care in their own units.

We found evidence of adverse events or critical incidents in60/154 medical cases and 27/134 surgical cases. Most of theissues were comparatively minor, commonplace problems that mightbe found in any hospital ward—for example, venflon cellulitis,over-infusion of intravenous fluids—but in at least 12medical cases and 16 surgical cases we found evidence of a lackof integrated care, in some cases with serious consequences.

Gannon thinks that we need to revitalise the role of the leadclinician.² Our findings support his contention. However, isthat possible and would it be enough? Over the past 20 years,hospital doctors have . . . [Full text of this article]

Graham Neale, visiting professor

g.neale@imperial.ac.uk, Clinical Safety Research Unit, Academic Department of Surgery, Imperial College, St Mary's Hospital, London W2 1NY

Sisse Olsen, research fellow

Clinical Safety Research Unit, Academic Department of Surgery, Imperial College, St Mary's Hospital, London W2 1NY