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Cited by 116Healthcare Quality and ManagementGlobal Maternal and Child HealthHealth Policy Implementation Science

Obstetric audit in resource-poor settings: lessons from a multi-country project auditing 'near miss' obstetrical emergencies

Open access
Filippi, V.·2004·Health Policy and Planning
DOI 10.1093/heapol/czh007
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Abstract

This paper outlines the practical steps involved in setting up and running multi-professional, in-depth case reviews of 'near miss' obstetrical complications. It draws on lessons learned in 12 referral hospitals in Benin, Côte d'Ivoire, Ghana and Morocco. A range of feasibility indicators are presented which measured the implementation and frequency of audit activities, the quality of participation, adherence to the planned protocol for the near-miss audits, the quality of audit discussions and the sustainability of the project. Although the principles of the audit approach were well accepted and implemented everywhere, near-miss audits appeared most successful in first referral level hospitals. Contextual factors that determine the successful implementation of near-miss audit include staff finding adequate time for audit activities, financial incentives to groups rather than individuals, involvement of senior staff and hospital managers, the ease of communication in smaller units, the employment of social workers for the incorporation of women's views at audits, and the strength of external support provided by the research team. The poor quality of information recorded in case notes was recognized everywhere as a deficiency, but did not present a major obstacle to effective case reviews. Ownership and leadership within the hospital, more easily achieved in the first-level referral hospitals, were probably the most important determinants of successful implementation. Sustainability requires a commitment to audit from policy makers and managers at higher levels of the health system and some devolution of resources for implementing recommendations.

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  • The quality of care provided by SBAs was identified as a problem and a clinical audit cycle commenced.

    “The quality of care provided by SBAs was identified as a problem and a clinical audit cycle commenced [20].”

    From Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment (2015) · cites this paper as [20]

    The ‘Introducing and piloting the audit approach’ section describes the start of a near-miss obstetric audit, and ‘Near-miss case review methods’ says staff reviewed care and made recommendations when it fell below standard. But the paper describes care provided by multidisciplinary hospital teams, including midwives and doctors; it does not specifically identify the quality of care provided by SBAs as the problem that prompted the audit. The indexed passages provide section labels but no page numbers. (LLM, conf=0.84)

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Research works printed but not linked: 4

  1. [1]1. Baker R. 1999. The role of clinical audit in changing performance. In: Baker R, Hearnshaw H, Robertson N (eds). Implementing change with clinical audit. Chisester: John Wiley and sons.
  2. [4]4. Crombie IK, Davies HTO, Abraham SCS, Florey C du V (eds). 1997. The audit handbook. Improving health care through audit. New York: John Wiley & Sons.
  3. [18]18. Kwast BE, Bekele M, Yoseph S et al. 1989. Confidential enquiries into maternal deaths in Addis Ababa, Ethiopia 1981-1983. Journal of Obstetrics and Gynaecology in East and Central Africa 8: 75-82.
  4. [23]23. Ronsmans C, Filippi V. Reviewing severe maternal morbidity: learning from women who survive life threatening compli- cations. In: Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Geneva: World Health Organization (in press).

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Authors
Filippi, V.
Affiliations
London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Filippi, V.
ORCID
Filippi, V.
Venue
Health Policy and Planning
Publisher
Oxford University Press (OUP)
Published
2004-01-01
Volume
19
Issue
1
Pages
57-66
ISSN
  • 0268-1080 (ISSN-L)
  • 1460-2237
DOI
10.1093/heapol/czh007
OpenAlex
W2134976793
Cited by
116
References
24
Citations by year
2026: 2 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 1 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 8 · 2015: 5 · 2014: 6 · 2013: 2 · 2012: 9
FWCI
10.39
Type
journal article
Language
en
Open access
Locations
  • Health Policy and Planning (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • European Commission
  • Department for International Development
Topics
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
obstetric emergencies, pregnancy complications, case review, quality improvement, resource-limited settings, audit implementation, hospital management, social workers, women's participation
MeSH terms
Africa, Developing Countries, Emergency Medical Services, Female, Humans, Maternal Welfare, Medical Audit, Obstetrics, Pilot Projects, Pregnancy, Pregnancy Complications

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