BMJ  2005;331:1143-1144 (12 November), doi:10.1136/bmj.331.7525.1143-b

Letter

Improving surveillance of MRSA bacteraemia

The tragedy of targets

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

EDITOR—Targets look good: they tend to be met. People put extra resources into targeted areas (that are therefore not available for non-targeted areas). Also, targeted areas are often newer and more high tech, so learning curves ensure improvement no matter what. When these mechanisms fail, various subtle gaming methods can be used.¹ None of these mechanisms has anything to do with improving hospital safety and quality. Targets are immediate but fixing systems is difficult and long term.

Spiegelhalter shows what happens when hospital acquired infections are made targets.² He also mentions but does not include difficulties with numerators and denominators in his calculations. With MRSA colonisation, the harder you look the more you find. Occupied bed days are frequently used denominators—at best a crude approximation to the true unmeasurable denominator of susceptible patients.

Hospital systems first need to work in a stable, reproducible, and predictable way and then . . . [Full text of this article]

Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia amor5444@bigpond.net.au

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