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Audit of compliance with antenatal protocols
1Joint Academic Unit of Obstetrics, Gynaecology, and Reproductive Physiology, St Bartholomew's Hospital Medical College, London.
BMJ (Clinical Research Ed.)
|November 14, 1992
Summary
Antenatal protocol compliance was poor, with only 23.5% of dictated actions performed. Implementation was better for early bookings and high-risk groups like older mothers and black women.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Quality Improvement
- Clinical Protocol Adherence
Background:
- Effective antenatal care relies on adherence to established risk-based protocols.
- Assessing protocol implementation is crucial for optimizing maternal health outcomes.
Purpose of the Study:
- To evaluate the adherence of clinical actions to protocols based on antenatal risk factors identified during initial visits.
- To identify factors influencing protocol implementation in a diverse obstetric population.
Main Methods:
- Retrospective analysis of 2000 deliveries between March 1990 and March 1991.
- Comparison of performed clinical actions against department-dictated protocols.
- Analysis stratified by clinical importance, booking gestation, maternal age, parity, ethnicity, and gestational age certainty.
Main Results:
- Overall compliance with dictated antenatal protocols was low (23.5%).
- Protocols for high-importance risk factors showed higher adherence (28.3%) than less important ones (18.6%).
- Improved compliance was observed for early booking (≤24 weeks), older mothers (≥36 years), black women, and uncertain gestational age cases.
Conclusions:
- Despite available resources (computer system, protocol manual), compliance with antenatal protocols was suboptimal.
- Early booking and specific high-risk maternal groups (older, black, uncertain gestation) demonstrated better protocol implementation.
- Further strategies are needed to enhance consistent protocol adherence across all patient demographics.