Correspondence (reply): In Reply

I wish to thank the authors of the two mentioned letters for adding important aspects. Dr Fuchs rightly points out that additional quality assurance measures will have to be provided by the existing staff, who are working to capacity. It would be the exception to have additional resources made available for such projects. This means that the time required for quality assurance is usually lacking at patients' bedsides, also because pre-existing bureaucratic requirements are usually not reduced. Well-meaning additional attempts to improve quality therefore lead, quasi by the back door, to reduced, and therefore poorer, patient care.

Dr Moreno mentions as a solution to this problem intelligent software, which may raise an alert if a defined treatment pathway has been abandoned, which would thus support the efforts of all parties involved to sustain high quality in a very economical and effective way. However, so far many hospital information technology systems seem to be lacking flexibility with regard to necessary interfaces with internally defined requirements. The fact that initial attempts in this direction have been put into practice (1) raises hopes for improved options in the future. In this way, optimized quality assurance would be possible while personal attention to patients could be maintained—a crucial factor in the success of any therapeutic attempt.