Methodological issues associated with an audit of stillbirth in a family medicine practice in Israel

An audit of 'deficient outcome' involves the step-by-step analysis of every event preceding the occurrence of a preventable medical outcome in order to determine exactly what went wrong. This paper describes methodological problems and related issues associated with a deficient outcome audit undertaken on five stillbirths which occurred in a rural family medical practice in Israel between 1985 and 1987. Problems included initial official disinterest towards the audit, and the high levels of suspicion and antagonism which it aroused in hospital staff approached for information. The problematic aspect of such audits needs more attention. The importance of this type of audit for establishing the precise reasons for perinatal deaths, and thus for maintaining antenatal care standards is discussed. In view of the small numbers of such events likely to occur within any one family practice it is not only feasible but also desirable for more family doctors to carry out such audits routinely, despite the difficulties which are involved.