Quality assurance in a large American perinatal center

The obstetric service of Hutzel Hospital in Detroit, Michigan is responsible for approximately 7,300 deliveries annually. To monitor the quality and appropriateness of patient care, recognize and pursue opportunities for improving care, and resolve identified problems in the obstetric service as well as other clinical areas, the hospital developed a quality assurance (QA) program. The application of clinical indicators represents the principal method by which relevant QA information is obtained. These indicators are designed to identify problems in patient care. The obstetric/gynecologic QA committee analyzes the results of this indicator-based review process as well as other information (appropriateness of surgery, drug usage, transfusions, utilization of hospital resources, etc.) and reports its findings to the full staff of the Department on a monthly basis. If necessary, actions are taken to correct problems. They include lectures, individual counselling, development of guidelines, addition of personnel and/or equipment, and indicated disciplinary actions. These remedial measures have led to improvements in clinical care such as, for example, a more appropriate usage of antibiotics and oxytocin, and stricter adherence to guidelines. More important, however, are the intangible changes in practice patterns that have occurred in that physicians and other members of the health care team tend to render care with an added degree of diligence and circumspection because of their awareness that an effective monitoring process exists.