Testing clinical audit of emergency obstetric care in Ghana and Jamaica.

One of the key contributors to the high rate of maternal mortality in developing countries is poor quality emergency obstetric care at referral level. In developed countries criterion-based clinical audit (CBCA) is now routinely used as part of quality assurance in health services. The audit team members who are not medically qualified screen medical records in order to determine whether the care received meets these criteria. The audit team and hospital staff then identify and implement actions to improve practice as required. In order to assess the feasibility and effectiveness of CBCA at district hospital level a study was conducted in two hospitals in Ghana and two in Jamaica. The types of obstetric complications chosen for audit were based on their life-threatening nature unambiguous definition and ability to be identified from hospital registers and patient records. They included obstetric hemorrhage eclampsia uterine rupture obstructed labor and sepsis. After devising working definitions for these conditions using best practice from relevant literature an assessment was made of baseline practice. Meetings were then held with hospital staff to encourage them to identify any poor quality management of the five life-threatening complications and how to improve including the setting of realistic targets for improvement. After 12 months of the action plan a second round of assessments using CBCA was conducted at the hospitals. Overall significant improvements were detected in the management of obstetric hemorrhage eclampsia and genital tract sepsis. Although there was some improvement in care for the other two complications the change was not statistically significant. Evidence of a continuing commitment to improving the quality of care at the four participating hospitals was reflected in the intention of staff to repeat the audit cycle until their targets were met and expand the process to other specialisms. (full text)