Using audit to monitor and improve the quality of anaesthesia for caesarean section.
OBJECTIVE
To improve the quality of anaesthesia for caesarean section by assessing the type and reason for using a particular anaesthetic; monitoring the incidence of anaesthetic complications or side effects; and measuring patient satisfaction with anaesthesia provided.


METHODS
Repeat audit undertaken retrospectively using a pre-designed database developed on EPI info public domain software.


METHODS
Maternity unit of a district general hospital.


METHODS
166 women undergoing emergency or elective caesarean section.


RESULTS
An initial audit involving 79 patients undergoing emergency and elective caesarean section revealed the following: 58.0 per cent of emergency sections and 45.5 per cent of elective sections were given general anaesthesia; "failure to progress" was indicated as the main reason for caesarean section in 27.8 per cent of cases; 25.3 per cent of patients experienced an anaesthetic-related complication or side-effect; and 90.3 per cent of patients were satisfied with their anaesthesia rising to 97.2 per cent after technical adjustment. The main findings were presented to the multi-disciplinary team staffing the unit. It was agreed that the quality of care could be further improved and changes to anaesthetic practice were quickly introduced. A subsequent re-audit of a further 87 patients showed a number of significant improvements: the overall use of general anaesthesia had fallen to 23.8 per cent from 53.0 per cent (P < 0.05); a noticeable reduction in the number of anaesthetic side-effects and complications had occurred, down from 25.3 per cent to 17.2 per cent of all sections; and patient satisfaction rates with anaesthesia provided were maintained.
Simmons
M
M
Inverclyde Royal NHS Trust, Larkfield Road, Greenock.
Bowie
P
P
Heatley
L
L
D000773:Anesthesia, Obstetrical / Q000592:standards*; D002585:Cesarean Section; D005260:Female; D006302:Health Services Research; D006801:Humans; D008485:Medical Audit; D011247:Pregnancy; D011787:Quality of Health Care; D012606:Scotland