The formal requirements of algorithms and their implications in clinical medicine and quality management.
OBJECTIVE
Clinical algorithms contribute to the problem- and priority-orientated management of patients and their disease in healthcare. Algorithms are of particular importance in all aspects of emergency medicine where the fast completion of a complex problem according to a hierarchy is required. The advantages and success of this priority- and problem-orientated concept led to its expansion to other subspecialties in medicine in recent years. However, in spite of algorithms being created based on defined norms, they are frequently violated in the literature, which renders the algorithm useless in a particular case.


METHODS
The present debate addresses these issues and provides the formal criteria and their necessary modification for creating sufficient clinical algorithms. In this context, we also clarify the misunderstandings between step-by-step schemes, decision trees, and algorithms, which are often used synonymously, and discuss their implications in clinical medicine and quality management.


RESULTS
A clinical algorithm can easily be created with the present derivation of the algorithm by its formal mathematical function using the corresponding norms describing specific symbols for a single criterion. Some symbol modifications as well as the usage of checklists to focus on the major criteria led to a rigorous reduction of the algorithm length and results in a clearer arrangement for routine clinical use. In clinical medicine, algorithms cannot only provide a fast access for solving complex problems but must also assure a transparent protocol and democratic treatment such that every patient receives the same quality of treatment. Thus, a treatment by chance can be excluded by standardization, which might impact the overall work needed to guide patients though diagnostics and therapy and may ultimately reduce cost. Algorithms are useful not only for quality in healthcare but also for undergraduate and continuous medical education. From a more philosophical point of view, we can raise the question of whether medical pathways and thereby the medical art should be disclosed to the general public by algorithms. Hippocrates form Kos held the view in the so-called Hippocratic Oath that medical art should only be revealed to medical scholars.


CONCLUSIONS
The present derivation and nomination of the formal requirements may lead to a better understanding of algorithms themselves as well as their development and generation.
Department of Surgery, Campus Innenstadt, Ludwig-Maximilians University, Nußbaumstr. 20, 80336, Munich, Germany. philipe.khalil@med.uni-muenchen.de
Philipe N
PN
Khalil
Axel
A
Kleespies
Martin K
MK
Angele
Wolfgang E
WE
Thasler
Matthias
M
Siebeck
Christiane J
CJ
Bruns
Wolf
W
Mutschler
Karl-Georg
KG
Kanz
D000465:Algorithms; D057189:Checklist / Q000592:standards; D019091:Critical Pathways / Q000592:standards; D003663:Decision Trees; D019317:Evidence-Based Medicine / Q000592:standards; D005858:Germany; D006801:Humans; D054527:Mass Casualty Incidents; D011785:Quality Assurance, Health Care / Q000592:standards; D012015:Reference Standards; D013561:Symbolism; D017749:Total Quality Management / Q000592:standards*; D014218:Triage / Q000592:standards