Obstetric anaesthesia: an approach to improving the standards of services

There has been considerable discussion about obstetric anaesthesia standards and about the role of peer review in quality improvement. We carried out two postal surveys in 1990 and 1991 in major obstetric departments in Northern England, in order to assess practice and facilities against professionally derived standards, with the aim of stimulating and reviewing change. The reference standards were a local adaptation of those produced by the Obstetric Anaesthetists Association, and covered operating facilities, anaesthetic equipment, management and manpower, training, and protocols. In 1990, considerable variation in practice and facilities was identified with deficiencies in all hospitals. After feedback of the results of the first survey, a further survey conducted in 1991 identified improvement in 23/26 standards. Reference to standards was widely included in business plans and contracts for services. Following further feedback of the second survey and some revision of standards, a third survey was carried out using site visits. This revealed further improvement in 8/26 standards, but apparent deterioration in 11/26. The overall change from the first to the third survey was of apparent improvement in 15/26 standards and deterioration in 6/26. Surveys of practice against professionally derived standards and the targeted feed back of results can lead to improvements in practice and facilities.