QUALITY ASSURANCE - MEASURING ITS EFFECT ON A BUSY OBSTETRIC SERVICE

Objective: To evaluate the effect of establishing a new quality assura nce program in obstetrics at a large teaching hospital. Methods: Seven obstetric clinical indicators were selected. After the computerized d ata base identified the patients as outliers from these indicators, th e medical record of each patient was reviewed. Each case was presented to the nine-member committee, which made recommendations or actions f or changes or improvement in patient care. The number of patients comi ng to review and the number of clinical indicators from the year befor e the program were compared to the results of the second year of the p rogram. Results: The new program significantly reduced the number of p atient records reviewed and the clinical indicators. Of the clinical i ndicators, prolonged hospitalization after both vaginal and cesarean b irths was decreased. Recommendations to the department included the ne ed for better chart documentation, specific educational presentations as grand rounds, and a protocol for antibiotic use for postpartum endo myometritis. Conclusion: A quality assurance program in obstetrics may decrease the number of clinical indicators after only 1 year. This de creasing trend and better documentation may be considered as measures of improvement in obstetric care. (Obstet Gynecol 1994;83:131-3)