Clinical audit to improve obstetric practice: What is the evidence?

Abstract

Background:

Clinical audit has been showed to improve professional practice from the providers’ perspective. However, little is known about the effect of audit on the quality of care from clients’ perspective.

Objective:

To assess the effectiveness of criterion-based audit to improve obstetric care from both the health professionals’ and clients’ perspectives.

Methods:

We conducted electronic searches of MEDLINE, EMBASE, and Cochrane Library in June 2009 for randomized controlled trials (RCTs) and before-and-after studies that assessed the effect of criterion-based audit on health outcomes or mothers/clients’ perception of obstetric care.

Results:

Twenty-three studies (one RCT and 22 before-and-after studies) involving 33,911 participants met our inclusion criteria. Only one of these studies assessed the effect of audit on quality of care from the mothers/clients’ perspective. Ninety-six percent (22/23) of studies showed significant improvement in at least one standard measured. In general clinical audit led to moderate improvements in obstetric care and the effect of audit depended on baseline adherence to clinical standards.

Conclusions:

Clinical audit is associated with moderate improvements in obstetric care from both the health professionals’ and mothers/clients’ perspectives. Audit has been used in obstetrics to improve quality mainly from one dimension, namely the health professionals’ perspective. Midwives/doctors should consider the use of audit to improve quality of care from the mothers/clients’ view.

Keywords::

• criterion-based audit
• audit and feedback
• obstetrics