title: Using audit to monitor and improve the quality of anaesthesia for caesarean section.
abstract: 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.
authors.affiliation: Inverclyde Royal NHS Trust, Larkfield Road, Greenock.
authors.forename: M
authors.initials: M
authors.lastname: Simmons
authors.forename: P
authors.initials: P
authors.lastname: Bowie
authors.forename: L
authors.initials: L
authors.lastname: Heatley
mesh_terms: 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