[Quality assurance of inpatient care--exemplified by surgery]

Internal quality assurance is natural for hospital physicians. External quality control is undertaken in cooperation with medical societies and sponsors-partly on voluntary basis. Despite considerable efforts in optimizing treatment procedures by classification of injuries and tumor stages, algorithms and tightly scheduled practical medical training, further control mechanisms are demanded; the economic drive is evident. In parallel to the introduction of quality control for services with a case-based flat rate, an interstructural result quality is desired. Hospital certification procedures are no longer utopian. The physician's duty for continuing medical education, which is set down in the professional code, has to be proven. The development of guidelines by scientific societies may help but is in need of a corrective. The medical chambers may play a particular role in this connection. Even if mechanisms of quality assurance differ, it is in the patient's interest that there must be no difference between ambulant and hospital care.