Markers to measure quality and safety in health care are much debated. A decline in adverse event reporting may represent a genuine decline in adverse events or merely a decline in their reporting; just as a rise in the reporting of poor outcomes may represent significant cultural changes in a healthcare system more vigilant or more responsible. While audits of quality control or patient satisfaction have their place, case reports are an opportunity to present well managed patients who have received good care; and, at the same time near misses promptly dealt with and complex cases well worked through.
Our aim is to become a repository of well managed cases. The cases need not be rare, indeed we learn much more from each other’s experience of pitfalls in common cases and rare presentations of common diseases. In the upcoming weeks we will present a series of cases that illustrate aspects of quality and safety in medicine and invite you to submit your experience of quality and safety in healthcare.
This is an example of a rare presentation of a common condition, recognised because of the vigilance of the medical team.