| Putting theory into practice: the introduction of obstetric near-miss case reviews in the Republic of Moldova. | |
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MedLine Citation:
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PMID: 22215758 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Quality issueThe 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.Initial assessmentProviders have limited experience with clinical audits and perceive them as a way to punish individuals.Choice of solutionNear-miss case reviews were introduced. Discussing near-miss cases might be less threatening to providers than discussing maternal deaths because the women survived.ImplementationThe quality of audits was evaluated against explicit criteria in three pilot maternities.EvaluationOn average one case was discussed every 5-6 weeks. Information from women's interviews was presented at all meetings, although the quality of the women's 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 (52-69%). Proposed actions were consistent with prior analysis (95-100%), formulated in a clear and measurable way (58-90%), 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.Lessons learnedIt is relatively easy to build capacity in organizing obstetric 'near-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. |
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Authors:
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Valentina Baltag; Véronique Filippi; Alberta Bacci |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-2 |
Journal Detail:
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Title: International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua Volume: - ISSN: 1464-3677 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-4 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9434628 Medline TA: Int J Qual Health Care Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 Making Pregnancy Safer Programme, World Health Organization (WHO) Regional Office for Europe, Copenhagen Ø, Denmark. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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