Doctors, Nurses, and Clinical Records

Previous work has suggested a number of relationships between structural characteristics of medical care units and the quality of medical performance. Detailed chart audits were carried out in five comprehensive child care clinics and measures of clinic structure and staff attitudes were also obtained, making it possible to examine some of the proposed relationships. No association was found between chart quality and hospital goals, levels of clinic bureaucracy, or physicians' training and qualifications. Quality of charts was lower in clinics with predominantly patient care rather than teaching and researchoriented physicians, and higher in clinics where nurses were assigned a major role. The hypothesis is advanced that quality of medical records will be higher under conditions most favorable to sharing of information within the medical team, particularly between doctors and nurses.