[Confidential enquiries and medical expert committees: a method for evaluating healthcare. The case of Obstetrics].
BACKGROUND
Confidential inquiries into dramatic events are a specific type of audit used to measure quality of care. Confidential inquiries have been conducted on maternal deaths in some European countries since 1920-30. In France, the first one was carried out in 1996. The number of these surveys is increasing, including in developing countries. Initially implemented in perinatology, they are also being carried out in other surgical or medical areas. The aim of this work was to describe the methods used and demonstrate their contribution to evaluating healthcare services.


METHODS
We reviewed the literature and studied several confidential inquiries. These inquiries were in-depth examinations conducted by peers of medical events leading to critical outcomes. They were based on scientific reasoning in an attempt to explain what happened. Strict confidentiality, for patients and healthcare providers, was assured. The different steps and rules of investigation were clearly defined.


RESULTS
About twenty confidential inquiries concerning perinatal events have been published worldwide. Other inquiries concerning anesthetic accidents, stroke with hypertension, or surgical complications have also been reported. Their principal contribution lies in the capacity to identify weaknesses in the healthcare service and care organization. Suboptimal care and avoidable factors of death were found in all cases. Most of the reports led to recommendations. These inquiries provide essential information for reorganizing current healthcare practices.


CONCLUSIONS
Confidential inquiries are needed to complete standard epidemiology surveys in evaluating healthcare and healthcare organization.
Bouvier-Colle
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INSERM, Unité 149 - Recherches épidémiologiques en santé périnatale et santé des femmes, 123, boulevard Port-Royal, 75014 Paris, France.
D000328:Adult; D003219:Confidentiality; D003625:Data Collection; D005260:Female; D005602:France; D006801:Humans; D008428:Maternal Mortality; D008499:Medical Records; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards*