BMJ  2007;334 (19 May), doi:10.1136/bmj.39217.615637.BE

Editor's Choice

Editor's choice

Improving patient care

One thing that unites BMJ readers must surely be their desire to improve patient care, whether through research, education, health systems management, or direct clinical contact with patients. But what does this really mean? A couple of months ago Don Berwick, president of the Institute of Healthcare Improvement (IHI), asked us what the BMJ's mission was. On hearing that is was, yes, to improve patient care (http://resources.bmj.com/bmj/sitemap/about-bmj/Our-vision-and-mission), he challenged us to get more concrete. What exactly did we want to improve and how?

This got us thinking. Those of you who have heard Don Berwick speak will know that he is a hard man to resist. (Those of you who haven't heard him speak can do so via the web cast on bmj.com of last month's International Forum on Quality and Safety in Health Care, in which he asks whether health care can even be safe (http://barcelona.bmj.com/). You'll find other inspirational speakers there too, including Richard Smith, former editor of the BMJ, talking about what the healthcare quality movement can learn from the movement to abolish slavery.)

So we came up with a plan. Might we choose a few key aspects of health care and focus on them? OK, but which aspects? There are hosts of prioritised lists drawn up by national and international groups, ranging from the US Institute of Medicine's funding priorities, and the WHO's priorities for drugs in Europe and the world, to the Institute for Healthcare Improvement's 5 million lives campaign and the UK's national service frameworks. The best of them are evidence based and used formal methods for reaching consensus among the expert panels.

Our plan is to ask BMJ readers. The first step is to find out what you think are the most important things doctors can do to make a difference to patient care. It may be home based palliative care, improving cardiovascular risk factors in type 2 diabetes, or preventing hospital infection. With the help of a panel drawn from our international editorial advisors, we will incorporate your nominations into a "list of lists" on which we will invite you to vote. As Domhnall Macauley explains, the top five or 10 aspects of care will become a focus of activity across the BMJ and its sister products. Send your nominations as a rapid response to his filler article (doi: 10.1136/bmj.39216.420625.DE).

This week's BMJ carries another new feature aimed at improving patient care: the first in a series of summaries of guidelines from the UK's National Institute of Health and Clinical Excellence (NICE). Our hope is to increase the chance that these world class, evidence based guidelines are put into practice, by getting the authors to crunch thousands of words down to two pages of key points. This week, Jennifer Hill and Tom Treasure summarise the recently published NICE guideline on reducing risk of venous thromboembolism in surgical patients (doi: 10.1136/bmj.39174.678032.AD). In a linked editorial, David Fitzmaurice and Ellen Murray highlight the continuing controversy over mechanical versus pharmacological approaches (doi: 10.1136/bmj.39210.496505.BE). But most compelling is the number of deaths each year caused by the failure to implement thromboprophylaxis. Here is most definitely a candidate for improvement.

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Relevant Articles

Thromboprophylaxis for adults in hospital

David A Fitzmaurice and Ellen Murray
BMJ 2007 334: 1017-1018. [Extract] [Full Text] [PDF]

Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance

Jennifer Hill, Tom Treasure on behalf of the Guideline Development Group
BMJ 2007 334: 1053-1054. [Extract] [Full Text] [PDF]

Making a difference: now it's your turn
BMJ 2007 334: 1055. [Extract] [Full Text]

Rapid Responses:

Read all Rapid Responses

Consistency is the last refuge of the unimaginative.

BM Hegde
bmj.com, 18 May 2007 [Full text]

How to improve patient care in a country where General Practice is less developed?

Christos Lionis
bmj.com, 8 Jun 2007 [Full text]