Design and evaluation of a regional perinatal audit.
OBJECTIVE
To describe the experiences of a regional audit of perinatal deaths, including the experiences of the audit members, to discuss similarities and differences with other, existing perinatal audits and to summarize the implications for future implementation.


METHODS
Perinatal audit with blinded regional auditors. Consecutive cases of perinatal death were analysed for the presence of substandard care. A random selection of cases was reviewed by an external audit panel. The prevalence of substandard care in the Amsterdam audit was compared with other, existing audits. A survey among audit members was executed.


RESULTS
Care providers from all Amsterdam hospitals, as well as general practitioners and independent midwives cooperated. One hundred thirty-seven perinatal deaths were reviewed. In 25% of all perinatal death cases, substandard care factors were present. After 23 completed weeks substandard care factors were present in 35% of cases, and in 52% of intrapartum deaths. These figures are comparable with other, non-regional oriented audits. The review of the external panel was also comparable to the review of the regional audit committee. All audit members felt secure to discuss freely the presence of substandard care.


CONCLUSIONS
First systematic experiences with a regional perinatal audit are described. We conclude that a regional perinatal audit is executable. Cooperation of regional care providers is good. Review of substandard care factors is comparable to other, non-regional oriented perinatal audits.
Alderliesten
Marianne E
ME
Academic Medical Centre Amsterdam, Department of Obstetrics and Gynaecology, Postbus 22660, 1100 DD Amsterdam, The Netherlands. marianne@alderliesten.com <marianne@alderliesten.com>
Stronks
Karien
K
Bonsel
Gouke J
GJ
Smit
Bert J
BJ
van Campen
Maarten M J
MM
van Lith
Jan M M
JM
Bleker
Otto P
OP
D054869:Clinical Audit / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000592:standards; D018743:Perinatal Care / Q000592:standards*; D054238:Perinatal Mortality; D011247:Pregnancy