Clinical Audit on Well Baby Services at Primary Health Care Corporation, Qatar

Abstract

Background: Regular well-baby visits during the first three years of childhood are critical to identify health, behavioral and development problems that could have long-lasting effects into adulthood. WHO stresses the importance of child health, and states that ensuring the healthy growth and development of children should be the prime concern. Aim: To ensure that well-baby services provide clinical care according to children’s age as per well-baby service protocol within primary health care centers, to find gaps if any and to generate an action plan for further improvement. Methodology: A retrospective chart review (baseline audit) was conducted on 245 health records of children who attended well-baby clinic for three months (March 01, 2018 to May 31, 2018). Further to the implementation of the action plan, a re-audit with retrospective chart review of 477 health records for three months (June 01, 2019 to August 31, 2019) was conducted to evaluate the improvements in the practice. Results: Performance for criterion on relevant clinical history taking (feeding and bowel history) has slightly increased from the baseline for each of the following age groups: from 71% to 82% at 4 months, 77% to 80% at 18 months and, 76% to 81% at 30 months, however, a declination was shown at 2 months 88% to 80%. Assessment of developmental milestones at 2, 18 and 30 months of age increased by 5% (76% to 81%), 13% (70% to 83%) and 19% (50% to 69%) respectively and, at 4 months performance remained the same at 69%. Examination of congenital hip dislocation/abduction has demonstrated a significant improvement where its performance increased by 79% (8% to 87%) at 2 months, and 82% (2% to 84%) at 4 months of age. On the other hand, at ages 18 & 30 months which were not measured in the baseline audit in the re-audit, it was 68% and 45% respectively. Screening for vision at 2 months of age has increased by 13% (78% to 91%), but, there was a slight drop of 10% in the screening of hearing from 86% to 76% at 2 months. Screening of autism spectrum disorder using a tool in children 18 and 30 months of age dropped from 86% to 83% and from 86% to 75% respectively. Conversely, request laboratory investigation to rule out anemia has increased by 46% (47% to 93%) at 18 months and 61% (23% to 84%) at 30 months. Conclusions: Impactful audits with actionable recommendations make real difference in practice and compliance. In conclusion, action plans implemented further to the baseline audit are effective in increasing the compliance in most of the areas. Key Words: Well-baby services audit, primary health care, Qatar