Putting theory into practice: the introduction of obstetric near-miss case reviews in the Republic of Moldova


Baltag, V; Filippi, V; Bacci, A; (2012) Putting theory into practice: the introduction of obstetric near-miss case reviews in the Republic of Moldova. International journal for quality in health care, 24 (2). pp. 182-188. ISSN 1353-4505 DOI: https://doi.org/10.1093/intqhc/mzr079

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Abstract

The quality of obstetric services remains a major issue in the Republic of Moldova. Services are well staffed and intensively used but do not deliver the expected outputs. Providers have limited experience with clinical audits and perceive them as a way to punish individuals. Near-miss case reviews were introduced. Discussing near-miss cases might be less threatening to providers than discussing maternal deaths because the women survived. The quality of audits was evaluated against explicit criteria in three pilot maternities. On average one case was discussed every 56 weeks. Information from womens interviews was presented at all meetings, although the quality of the womens interviews was low. The weakest aspect of care was monitoring and follow-up treatment; the majority of proposed actions concerned the availability or compliance to protocols (5269). Proposed actions were consistent with prior analysis (95100), formulated in a clear and measurable way (5890), but the rate of failure to identify important actions was quite high in one facility (33). Actions were more likely to be implemented when they concerned organization and management, drugs and supplies and least likely when they concerned staff. It is relatively easy to build capacity in organizing obstetric onear-miss' audits, but more difficult to ensure that discussions are transposed into actions. In settings with no tradition of patients involvement, increased attention should be given to providers capacity to tackle patient-related factors.

Item Type: Article
Keywords: medical audit (MeSH), pregnancy complications (MeSH), obstetric labour, complications (MeSH), emergency obstetric care, onear-miss', maternal morbidity, audit, care, guidelines, feedback, quality
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Maternal Health Group
PubMed ID: 22215758
Web of Science ID: 301302900012
URI: http://researchonline.lshtm.ac.uk/id/eprint/24137

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