Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity

Abstract

Background Audit and feedback of critical incidents is an established part of obstetric practice. However, the effect on perinatal and maternal mortality is unclear. The potential harmful effects and costs are unknown. Objectives Is critical incident audit and feedback effective in reducing the perinatal mortality rate, the maternal mortality ratio, and severe neonatal and maternal morbidity? Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 November 2010) and the Cochrane Effective Practice and Organisation of Care Group’s Trials Register (18 November 2010). Selection criteria Randomized trials of audit (defined as any summary of clinical performance over a specified period of time) and feedback (method of feeding that information back to the clinicians) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis No suitable trials were found. Main results None. Authors’ conclusions The necessity of recording the number and cause of deaths is not in question. Mortality rates are essential in identifying problems within the healthcare system. Maternal and perinatal death reviews should continue to be held, until further information is available. The evidence from serial data clearly suggests more benefit than harm. Feedback is essential in any audit system. The most effective mechanisms for this are unknown, but it must be directed at the relevant people.

Making It Happen: Training health-care providers in emergency obstetric and newborn care

“…Improving quality of care using audit, including maternal and perinatal death audit and standards-based audit A Cochrane systematic review on audit and feedback concluded that audit can improve professional practice [58,59]. What is also clear is that audit is a method of evaluating and documenting what is so often lacking in the health system or 'enabling environment' with regard to personnel, skills, equipment or drugs to be able to provide at least the minimum acceptable level of care.…”

Perinatal mortality audit: Counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries

“…We conducted a random effects meta-analysis using STATA version 10.0 statistical software (STATA Corp, College Station, TX, USA) and report the Mantel-Haenszel pooled risk ratio and corresponding 95% confidence interval (CI). Assessment of the impact of perinatal mortality audit is complex because the audit cycle and implementation of recommended actions are rarely carried out as part of a randomized trial [22] and other factors may also contribute to a measured reduction in mortality. One recent systematic review of interventions to prevent stillbirths identified 1 review and 12 intervention studies on the impact of perinatal mortality audit, with the majority from high-income countries.…”

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

“…Methodical and detailed case review is commonly used as a strategy to improve health professionals' care of pregnant women, 190 not only through documenting the number and causes of morbidity and mortality, but also through identifying preventable factors. 3,9 Two approaches have been taken nationally to learning from adverse incidents in maternity care: external anonymised case review (confidential enquiries) 2,3 and local (facility-based) reviews using tools such as root cause analysis.…”