Abstract
BackgroundObstetric 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.MethodsWe 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.ResultsAudit 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%).ConclusionsThe 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.
Highlights
Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries
In this paper we report the experience of introducing audits in hospitals in Benin, West Africa, and document the extent to which audit teams could identify Case Management Problem (CMP), analyse their causes, agree on solutions and put these solutions into practice
The audit intervention In 1999 we introduced obstetric near-miss case reviews in five hospitals in Southern Benin
Summary
Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. Direct complications of pregnancy and childbirth contribute, in Africa, approximately 68% to this mortality [2] Such complications usually require emergency obstetric care in district hospitals, where IV therapy, blood transfusion, general anaesthesia, caesarean section etc. Audits come in various guises, but have in common that they seek to identify and analyse shortcomings systematically, and to design and implement interventions to prevent such shortcomings in the future [7] They operate on the assumptions that shortcomings are learning opportunities and ought to be used as such, that health workers in general wish to perform well but need support for doing so, and that, except in cases of gross negligence or malevolence, encouragement and assistance are more effective than punishment
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