Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity.
BACKGROUND
Audit and feedback of critical incidents is an established part of obstetric practice. However, the effect on perinatal and maternal mortality is unclear. The potential harmful effects and costs are unknown.


OBJECTIVE
Is critical incident audit and feedback effective in reducing the perinatal mortality rate, the maternal mortality ratio, and severe neonatal and maternal morbidity?


METHODS
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (January 2005), the Cochrane Effective Practice and Organisation of Care Group Trials Register (January 2005), MEDLINE (1965 to December 2004), EMBASE (1965 to December 2004), SCIBASE (1965 to December 2004) and the World Health Organization systematic review of maternal mortality and morbidity database (January 1997 to December 2002).


METHODS
Randomized trials of audit (defined as any summary of clinical performance over a specified period of time) and feedback (method of feeding that information back to the clinicians) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes.


METHODS
No suitable trials were found.


RESULTS
None.


CONCLUSIONS
The necessity of recording the number and cause of deaths is not in question. Mortality rates are essential in identifying problems within the healthcare system. Maternal and perinatal death reviews should continue to be held, until further information is available. The evidence from serial data clearly suggests more benefit than harm. Feedback is essential in any audit system. The most effective mechanisms for this are unknown, but it must be directed at the relevant people.
Pattinson
R C
RC
University of Pretoria, Department of Obstetrics and Gynaecology, Kalafong Hospital, Private Bag X396, Pretoria, Gauteng, South Africa 0001. rcpattin@kalafong.up.ac.za
Say
L
L
Makin
J D
JD
Bastos
M H
MH
D002423:Cause of Death; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D008485:Medical Audit; D009017:Morbidity; D011247:Pregnancy