Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105657

Patricia E. Bailey, DrPH, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, (919) 544-7040 x 523, pbailey@fhi.org, Ha Thanh Binh, MD, Save the Children, 141 Le Duan Street, Hanoi, Vietnam, and Hoang Thi Bang, MD, UNFPA, 1st Floor, UN Apartment Building, 2E Van Phuc Compound, Hanoi, Vietnam.

Medical audits are performed to improve clinical or managerial practices, to enhance the rational use of limited resources, and to improve staff morale and motivation. The obstetric staff at 5 hospitals in Thanh Hoa and Quang Tri provinces identified a series of clinical and managerial problems and used criteria-based audit (CBA) as a tool for quality improvement. Collectively they addressed 7 issues such as the management of postpartum hemorrhage, severe pre-eclampsia, prolonged labor, and indications for cesarean delivery. CBA compares current practice as documented in patient records and registries with standards and guidelines based on the best available evidence. The audit cycle begins with an initial assessment and data collection, analysis of those data, formulation of an action plan based on the analysis, implementation of the plan, and a re-evaluation of the initial situation. Statistical testing was performed with PEPI software. Teams found that clinical protocols were not followed although the National Standards and Guidelines for Reproductive Health Care Services had been issued the year before; different providers treated complications like severe pre-eclampsia or postpartum hemorrhage differently. In an audit of “managerial practices,” staff identified obstacles in the timely referral of patients needing emergency care during off-hours. Teams devised mechanisms to correct specific problems and every audit documented significant improvements. The audits reinforced national guidelines, improved record-keeping, enhanced teamwork and provided staff with a sense of satisfaction that they could solve their own problems. Response has been positive and the government may decide to expand the training in CBA to the rest of the country.

Learning Objectives:

Participants of the session will
• be able to describe the audit cycle,
• recognize how CBA helped staff resolve specific problems related to the management of obstetric complications, and
• assess the use of CBA as a quality improvement tool that is entirely self-directed

Keywords: Maternal Morbidity, Vietnam

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.