Quality assurance: measuring its effect on a busy obstetric service.

Abstract

To evaluate the effect of establishing a new quality assurance program in obstetrics at a large teaching hospital. Seven obstetric clinical indicators were selected. After the computerized data base identified the patients as outliers from these indicators, the medical record of each patient was reviewed. Each case was presented to the nine-member committee, which made recommendations or actions for changes or improvement in patient care. The number of patients coming to review and the number of clinical indicators from the year before the program were compared to the results of the second year of the program. The new program significantly reduced the number of patient records reviewed and the clinical indicators. Of the clinical indicators, prolonged hospitalization after both vaginal and cesarean births was decreased. Recommendations to the department included the need for better chart documentation, specific educational presentations as grand rounds, and a protocol for antibiotic use for postpartum endomyometritis. A quality assurance program in obstetrics may decrease the number of clinical indicators after only 1 year. This decreasing trend and better documentation may be considered as measures of improvement in obstetric care.