Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin

BMC Pregnancy and Childbirth

Véronique Filippi²  Lydie Kanhonou⁴  Jacques Saizonou⁴  Thérèse Delvaux³  Eusèbe Alihonou⁴  Sourou Goufodji⁴  Matthias Borchert¹ 

[1] Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany;Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK;Institute of Tropical Medicine, Antwerp, Belgium;Centre pour la Recherche en Reproduction Humaine et Démographie, Cotonou, Benin

关键词: West Africa;    Benin;    Audit;    Quality assurance;    Near-miss complications;    Obstetrics;   

Others  :  1152201
DOI  :  10.1186/1471-2393-12-109

 received in 2012-04-12, accepted in 2012-10-02,  发布年份 2012

【 摘 要 】

Background

Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice.

Methods

We analysed case summaries, women’s interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams.

Results

Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%).

Conclusions

The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established.

【 授权许可】

   
2012 Borchert et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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