Correspondence (letter to the editor): Influence of Supporting Feedback

Implementation of guidelines into clinical practice is regarded as the main requirement for future quality assurance. Active dissemination of clinical pathways with prompt feedback, as detailed by the authors, leads to practical additions to today`s retrospectively oriented processes of quality assurance (1). A high amount of good quality guidelines with a high density of information exists. Therefore a practical way for broad implementation via flexible and case-related workflows is required (2). Guideline knowledge alone does not have a remarkable influence on the clinician's behavior as mentioned in the study (2). Appropriate feedback loops can gain the physician’s attention to leaving the pathway recommended by guidelines.

Supporting feedback delivered by intelligent software solutions is increasingly used in clinical practice. It is obvious that the user of IT systems should always be allowed to ignore and even dismiss recommendations by the system. Deviation from the clinical guideline recommendations, however, is documented in almost all existing electronic support systems and can later be evaluated within the scope of structured quality management. Without question, close and continuous discussion about adherence to the pathway with a respected and instructing physician is of high value. However this should not lead the conclusion “either ... or” but “as well as”. IT supported systems cannot replace instructing expert physicians, but should support them in in their endeavor to achieve high quality by providing of continually increasing amounts of patient-related data.

The study by Steinacher and colleagues is a step in the right direction.