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Publication Type
Journal Article
UWI Author(s)
Author, Analytic
Wagaarachchi, P. T.; Graham, W. J.; Penney, G. C.; McCaw-Binns, Affette M.; Yeboah Antwi, K.; Hall, M. H.
Author Affiliation, Ana.
Department of Community Health and Psychiatry
Article Title
Holding up a mirror: Changing obstetric practice through criterion-based clinical audit in Developing Countries
Medium Designator
n/a
Connective Phrase
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Journal Title
International Journal of Gynaecology and Obstetrics
Translated Title
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Reprint Status
n/a
Date of Publication
2001
Volume ID
74
Issue ID
2
Page(s)
119-131
Language
eng
Connective Phrase
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Location/URL
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ISSN
0020-7292
Notes
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Abstract
The objective of the study described is to assess the feasibility and effectiveness of using a criterion-based clinical audit to measure and improve the quality of obstetric care at the district hospital level in Developing Countries. The focus is on the management of five life-threatening obstetric complications--hemorrhage, eclampsia, genital tract infection, obstructed labor and uterine rupture was audited using a 'before and after' design. The five steps of the audit cycle were followed: establish criteria of good quality care; measure current practice (Review I); feedback findings and set targets; take action to change practice; and re-evaluate practice (Review II). Systematic literature review, panel discussions and pilot work led to the development of 31 audit criteria. Review I included 555 life- threatening complications occurring over 66 hospital-months; Review II included 342 complications over 42 hospital-months. Many common areas for improvement were identified across the four hospitals. Agreed mechanisms for achieving these improvements included clinical protocols, reviews of staffing, and training workshops. Some aspects of clinical monitoring, drug use and record keeping improved significantly between Reviews I and II. Criterion-based clinical audit in four typical district hospitals in Ghana and Jamaica is a feasible and acceptable method for quality assurance and appears to have improved the management of life-threatening obstetric complications.....
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