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Multicentre criterion based audit of the management of induced abortion in Scotland.

Abstract：

OBJECTIVES:To assess and improve the quality of care provided to women undergoing induced abortion. DESIGN:Two rounds of prospective, criterion based case note review audit. SETTING:Ten NHS gynaecology units throughout Scotland. SUBJECTS:2004 patient episodes of abortion care identified consecutively during two rounds of audit. The first round comprised 967 cases and the second round 1037. INTERVENTIONS:Dissemination of results from the first round of audit and recommendations for change in the form of a written report and at postgraduate meetings in participating hospitals. MAIN OUTCOME MEASURES:Improvements in quality of care as assessed against 16 previously agreed criteria, both overall across the 10 study hospitals and within individual hospitals. RESULTS:Overall, four significant improvements occurred: increased availability of early medical abortion, decreased utilisation of surgical abortion at very early gestation, increased use of mifepristone priming before second trimester medical abortion, and increased provision of follow up. At the individual hospital level 42 of 150 elements of care studied were "close to optimal" at the time of the first round of audit, rising to 54 at the second round (NS). A total of 31 significant improvements in individual elements of care occurred, but 11 significant deteriorations also occurred (at the P < 0.05 level). CONCLUSIONS:The prospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care. The audit results prompted objective review of local abortion services in participating hospitals. At least for some elements of care in some hospitals significant improvements were detectable. :The objective was to assess and improve the quality of care provided to women undergoing induced abortion. Two rounds of prospective, criterion-based case note review audit were carried out in 10 National Health Service gynecology units throughout Scotland, and 2004 patient episodes of abortion care were identified. The first round comprised 967 cases and the second round 1037. Significant improvements occurred in quality of care as assessed against 16 previously agreed upon criteria across the 10 study hospitals and within individual hospitals. These included increased availability of early medical abortion, decreased utilization of surgical abortion at very early gestation, increased use of mifepristone priming before 2nd trimester medical abortion and increased provision of follow up. At the individual hospital level, 42 of 150 elements of care studied were close to optimal at the time of the first round of audit, rising to 54 at the second round. A total of 31 significant improvements in individual elements of care occurred, but 11 significant deteriorations also occurred at the p 0.05 level. At the time of the 2nd round of audit 4 significant overall improvements across the 10 hospitals were detected: the use of medical abortion for women at 9 weeks' gestation rose from 39 to 516 (7.6%) to 172 of 541 (31.8%) (p0.0001); the inappropriate use of surgical abortion in women at 7 weeks' gestation decreased from 68 of 85 (80.0%) to 56 of 98 (57.1%) (p=0.0017); the use of mifepristone cervical priming before midtrimester medical abortion increased from 15 of 64 women (23.4%) to 64 of 102 (62.7%) (p 0.0001); the recording of a follow up arrangement in the case notes increased from 52% to 69% of cases (p=0.037), and the advising of follow up within the recommended interval of two weeks after abortion also increased (from 5% to 32%; p=0.0645). There were no overall deteriorations in relation to any elements of care. The prospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care.

journal_name

BMJ

journal_title

BMJ (Clinical research ed.)

authors

Penney GC,Glasier A,Templeton A

doi

10.1136/bmj.309.6946.15

subject

Has Abstract

pub_date

1994-07-02 00:00:00

pages

15-9; discussion 18-9

issue

6946

eissn

0959-8138

issn

1756-1833

journal_volume

309

pub_type

杂志文章,多中心研究

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Multicentre criterion based audit of the management of induced abortion in Scotland.