Monitoring quality of audit in obstetrics and gynaecology

To develop a questionnaire to assess audit activity and to use it to evaluate systematically the quality of audit in obstetrics and gynaecology within NHS hospitals in the UK.

Retrospective review of 212 consecutive questionnaires completed at hospital recognition committee visits for training accreditation, between 1 January 1993 and 31 August 1998, validated against hospital trust annual audit reports.

Use of seven quality criteria developed within the Royal College of Obstetricians and Gynaecologists clinical audit unit and also assessment of support for audit and participation in regional and national audit. Results were compared between 1993/4 (n = 72), 1995/6 (n = 72), and 1997/8 (n = 68) for evidence of improvement.

After modifications to the questionnaire the version used from 1993 proved to be a satisfactory tool with minimal need for subsequent change. The results showed that there has been a significant improvement in the quality of obstetric and gynaecology audit with time (p < 0.0001) with 36 (53%) of departments in the previous two year period meeting all seven criteria. Similarly by this stage, 60 (88%) of departments had reached the stage of re-audit and 55 (81%) had conducted patient satisfaction surveys, both of these having significantly improved with time. Critical incident monitoring also became used more widely with time. Validation of topics audited was possible for 45% of hospitals where trust annual audit reports were available and these showed a high level of correlation.

It has proved possible to conduct an audit of audit using the current system of hospital recognition visits for training accreditation. This has shown a great variety in the depth and breadth of audit that is being undertaken within individual obstetric and gynaecology departments. Since 1993 there has been an improvement in the quality of audit programmes undertaken, in particular in the number of hospitals carrying out critical incident monitoring, patient satisfaction surveys, and re-audit. This should be associated with improvements in staff training and in patient care.