Professional responsibility in maternity care: role of medical audit

Abstract

PIP: In 1965, Baroda (India) Medical College started a medical audit process into maternal and perinatal deaths, and consultation in peripheral medical facilities providing prenatal and obstetric care. Record forms were designed. Weekly departmental meetings of all teaching staff and residents were held. A committee was formed to keep confidential records of all maternal deaths. 6 to 8 meetings of staff and residents were held annually to discuss maternal and perinatal deaths. Data on obstetric cases and maternal deaths were compiled an distributed to staff and residents. The staff and residents visited primary health centers (PHCs) to provide prenatal care. 6 PHCs were selected. Ward nurses held meetings every other week to discuss nursing aspects of complicated cases. The data showed that in 1967-68 the following might have led to maternal deaths. Consultants attended 75% of the maternal deaths. Residents managed 25% of the obstetric emergencies without consulting the attending physician. Common mistakes by residents are listed. In 4% of the maternal deaths, there was a delay in performing cesarean sections. Residents performed more obstetric procedures at night that resulted in maternal deaths than cases that were managed by consultants. Maternal mortality was higher on weekends and holidays as a result of inadequate staffing. In 1983-84 errors in judgment by members of the obstetric department were responsible for 1.5% of maternal mortality as compared to 10% in 1967-68. The main drawbacks in teaching institutions in the developing world include: 1) failure to supervise junior staff; 2) failure of consultants to examine patients before prescribing treatment; and 3) allowing juniors to perform obstetric procedures in high risk cases without monitoring.