Many patients experience posttraumatic stress disorder following a stay in intensive care; this can be due to a lack of recall of their stay. Retrospective patient diaries (n = 8) with follow-up have been used to try and help patients' recovery but have been found to be impersonal. Prospective diaries (n= 35) were implemented and trialled with follow-up at 2, 6 and 12 months postdischarge. Patients' and relatives' initial feedback regarding diaries is extremely positive. Benefits included better understanding of the events of the critical illness, helping with more realistic goal setting during the recovery period, improving communication within families through discussion of the diary and providing a source of comfort for the bereaved. More formal audit of these diaries is required and is currently being undertaken.

SummaryIn September 1978 a postal survey was made to establish the influence of continuous fetal heart rate monitoring on clinical practice in 264 Consultant Obstetric Units in the United Kingdom. Replies were received from 244 units (92·4 per cent) and only one of these did not possess any fetal heart monitors. The approximate percentage of patients monitored during labour in these units displayed a bimodal distribution with peaks at 20 to 30 and 80 to 90 per cent, reflecting a division of opinion about the need to monitor all or only ‘high risk’ patients. For each hospital the ratio of the numbers of patients delivered during 1977 to the number of monitors was calculated and the values ranged from 172 to 2708. In nearly 25 per cent of the hospitals it was not possible to monitor all high risk patients. Fetal blood pH estimation was used in conjunction with fetal heart rate measurement in 98 hospitals (40·2 per cent) but 38 (15·6 per cent) had a pH meter in or adjacent to the labour ward although this was not used for pH estimation. Midwives were taught to apply fetal scalp electrodes in half of the units but were taught to collect fetal blood samples in only two. It is suggested that there is a need (i) to improve the monitoring facilities in many units, (ii) to encourage midwives to become more involved in practical monitoring techniques and (iii) to develop improved methods for fetal pH determination during labour.

A microcomputer system is described which stores data for perinatal audit and produces 'on-line' the statutory birth notification form and mother and baby discharge summary. The derivation of a minimum data-base and the methods used to obtain reliable data are outlined. The results of a trial of the production of the birth notification form for 195 deliveries are reported together with those of a further trial of 86 deliveries in which the system was used to produce both the notification form and the discharge summary. A study of the accuracy of the handwritten birth notification forms revealed a high error rate which was markedly reduced by the use of the microcomputer system. The system is now in routine use and further developments are outlined.

No abstract