Holding up a mirror: changing obstetric practice through criterion-based clinical audit in developing countries

The objective of the study described is to assess the feasibility and effec tiveness of using a criterion-based clinical audit to measure and improve t he quality of obstetric care at the district hospital level in developing c ountries. 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. T he five steps of the audit cycle were followed: establish criteria of good quality care; measure current practice (Review I); feedback findings and se t 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-threateni ng complications occurring over 66 hospital-months; Review II included 342 complications over 42 hospital-months, Many common areas for improvement we re identified across the four hospitals. Agreed mechanisms for achieving th ese improvements included clinical protocols, reviews of staffing, and trai ning workshops. Some aspects of clinical monitoring, drug use and record ke eping improved significantly between Reviews I and II. Criterion-based clin ical audit in four typical district hospitals in Ghana and Jamaica is a fea sible and acceptable method for quality assurance and appears to have impro ved the management of life-threatening obstetric complications. (C) 2001 In ternational Federation of Gynecology and Obstetrics. All rights reserved.