Use of criterion‐based clinical audit to improve the quality of obstetric care: A systematic review

Abstract

Although there is evidence that audit and feedback can improve health outcomes, little is known about the effect of audit on the quality of care from client's perspective. The aim of the current review was to explore the use of criterion-based audit to improve quality of obstetric care from both the midwives/doctors' and women/mothers' perspectives. Electronic searches of Cochrane Library, MEDLINE, and EMBASE were conducted. Randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or women/mothers' perception of obstetric care were set as selection criteria. Data were extracted, analyzed using Revman 4.2 software, and results expressed as weighted mean differences for continuous data, and odds ratios for dichotomous data. Nineteen studies (one RCT and 18 before-and-after studies) involving 32,972 participants met our inclusion criteria. None of these studies assessed the effect of audit on quality from the women/mothers' perspective and none of the studies compared the effectiveness of different types of feedback. Ninety-five percentage (18/19) of studies showed significant improvement in at least one standard measured. Criterion-based audit has been used in obstetrics to improve quality from one dimension, namely the midwives/doctors' perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers' view. There is need for well-designed RCTs to assess the effectiveness of different types of feedback in criterion-based audit.

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

“…Lack of regular quality supervision and evaluation was an important barrier to improving the effectiveness of standard care practices 72 75. Audit and feedback could be a useful tool in improving adherence to regulations and standard care and improving their effectiveness across countries worldwide,20 26 76–79 but there are challenges related to quality,26 77 78 sustainability76 and acceptance of audit,77 especially when enforced by an external agency 76…”

Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

“…Following audit, feedback is an important step to improving care, [42] and will be our next goal, beginning with grand rounds in our hospital. Further education of care providers about the importance of documentation in general and about the content of guidelines, such as the weight gain guidelines, will be important.…”

Using a Caesarean Section Classification System based on characteristics of the population as a way of monitoring obstetric practice

“…The current study has identifiable limitations, the design as a before and after evaluation, the time period considered was diminutive and its initial purpose was to focus on the effect of Audit and Feedback [19,20] as an implementation method to study six obstetric practices underwritten by evidence-based medicine. The intervention was not initially planned to reduce caesarean rates, however, three of the practices selected could be able to reflect on a decrease of caesareans: continuous support during labour and childbirth by a companion, do not perform continuous electronic fetal monitoring (EFM) during labour of low risk pregnant women and to induce labour in low risk pregnancies when reaching 41 weeks of gestational age.…”