[Aspects of quality assurance in a rheumatology clinic. A contribution to the problem of length of stay and unnecessary admission].

In a rheumatological hospital, quality assurance has many aspects. Diagnostic as well as classification criteria are essential; however, they should not be regarded as a strait-jacket. The very important radiological diagnostics require optimal technology. All x-ray-pictures should only be interpreted by experienced rheumatologists. Also of importance is the documentation of all relevant data, sometimes for decades, especially the kind of drugs, their effectiveness and side effects and the assessment of activity, stage, progression and functional ability. Very important is also a close communication with other medical disciplines. Nursing in rheumatology is mostly underestimated quantitatively and qualitatively as well; it cannot be compared with nursing in other patients. Physical and occupational therapy are indispensable parts of treatment of in-patients; under certain conditions, they may have priority in comparison to other treatments. For chronobiological reasons, physical therapy has a definite time requirement. A duration of 3 weeks is necessary to get therapeutically desired adaptation processes. Thus, the duration of stay in rheumatological departments must be longer than in other disciplines. An actual questionnaire, which has been sent to 50 rheumatological departments, asked the question, which reasons and indications will make future in-patient treatment necessary. As main reason, the comprehensive treatment options and induction of a special pharmacotherapy have been mentioned. Also an element of quality assurance in a rheumatological hospital is warmheartedness and humanity.