MULTICENTER CRITERION BASED AUDIT OF THE MANAGEMENT OF INDUCED-ABORTION IN SCOTLAND

Objectives-To assess and improve the quality of care provided to women undergoing induced abortion. Design-Two rounds of prospective, criter ion based case note review audit. Setting-Ten NHS gynaecology units th roughout Scotland. Subjects-2004 patient episodes of abortion care ide ntified consecutively during two rounds of audit. The first round comp rised 967 cases and the second round 1037. Interventions-Dissemination of results from the first round of audit and recommendations for chan ge in the form of a written report and at postgraduate meetings in par ticipating hospitals. Main outcome measures-Improvements in quality of care as assessed against 16 previously agreed criteria, both overall across the 10 study hospitals and within individual hospitals. Results -Overall, four significant improvements occurred: increased availabili ty of early medical abortion, decreased utilisation of surgical aborti on at very early gestation, increased use of mifepristone priming befo re second trimester medical abortion, and increased provision of follo w up. At the individual hospital level 42 of 150 elements of care stud ied were ''close to optimal'' at the time of the first round of audit, rising to 54 at the second round (NS). A total of 31 significant impr ovements in individual elements of care occurred, but 11 significant d eteriorations also occurred (at the P < 0.05 level). Conclusions-The p rospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care. The audit results prompted objective review of local abortion services in participating hospitals. At least for some elements of ca re in some hospitals significant improvements were detectable.