|11. What is the Evidence for the Role of Audits to Improve the Quality of Obstetric Care|
In recent years, audit has become an acquired concept in the context of health services, and medical or clinical audit is now an accepted part of routine practice in many hospitals in Western countries. There is still much confusion as to what the word audit actually means however. As (Crombie et al. 1997, p2) state: There are many approaches to audit, and almost as many views on how audit should be conducted as there are authors on the subject. The ultimate aim of audit, that it should lead to improvements in patient care, is perhaps the only aspect on which there is consensus (Crombie et al . 1997). Audit, indeed, sets out to raise the quality of health care, and is in many ways similar to quality assurance or total quality management. Audit is about what is or ought to be the most essential concern of any health professional: to optimize clinical performance and provide the best possible services to patients.
It is not the intention of this paper to provide a comprehensive overview of the history of and approaches to audit, as many excellent overviews already exist (Crombie et al. 1997, Smith 1992, Lawrence & Schofield 1993). Instead, by using examples of applications of audit in the context of obstetric care, it will introduce some important concepts and principal methods of audit. Audit is not unique to obstetric care, but one of the oldest and highly influential examples of audit emerged from a desire to improve obstetric care. The Confidential Enquiries into Maternal Deaths, introduced as early as 1952 in the United Kingdom, are one of the first systematic initiatives to improve the quality of health care (Department of Health and Social Security 1982). This and other examples of audits of obstetric care will serve to illustrate the particular concerns that have surrounded obstetric care, and the efforts that have been made to improve it. Lessons will be drawn for application to developing countries, and examples of audit experiences in developing countries will be sought. Finally, the big, and as yet unanswered question of whether audit can improve care, let alone obstetric care, will be addressed briefly.