title: Clinical audit: a useful tool for reducing severe postpartum haemorrhages?
abstract: OBJECTIVE
  Reducing the rate of severe postpartum haemorrhage (PPH) is a major challenge in obstetrics today. One potentially effective tool for improving the quality of care is the clinical audit, that is, peer evaluation and comparison of actual practices against explicit criteria. Our objective was to assess the impact of regular criteria-based audits on the prevalence of severe PPH.
  
  
  METHODS
  Quasi-experimental before-and-after survey.
  
  
  METHODS
  Two French maternity units in the Rhône-Alpes region, with different organization of care.
  
  
  METHODS
  All staff of both units.
  
  
  METHODS
  Quarterly clinical audit meetings at which a team of reviewers analysed all cases of severe PPH and provided feedback on quality of care and where all staff actively participated.
  
  
  METHODS
  The primary outcome was the prevalence of severe PPH. Secondary outcomes included the global quality of care for women with severe PPH, including the performance rate for each recommended procedure. Differences in these variables between 2005 and 2008 were tested.
  
  
  RESULTS
  The prevalence of severe PPH declined significantly in both units, from 1.52 to 0.96% of deliveries in the level III hospital (P = 0.048) and from 2.08 to 0.57% in the level II hospital (P < 0.001). From 2005 to 2008, the proportion of deliveries with severe PPH that was managed consistently with the guidelines increased for all of its main components, in both units.
  
  
  CONCLUSIONS
  Regular clinical audits of cases severe PPH were associated with a persistent reduction in the prevalence of severe PPH.
authors: Re´seau pe´rinatal Aurore, Hoˆpital de la Croix Rousse, Universite´ Lyon 1, Lyon, France.
authors: Corinne
authors: C
authors: Dupont
authors: Catherine
authors: C
authors: Deneux-Tharaux
authors: Sandrine
authors: S
authors: Touzet
authors: Cyrille
authors: C
authors: Colin
authors: Marie-Hélène
authors: MH
authors: Bouvier-Colle
authors: Jacques
authors: J
authors: Lansac
authors: Simone
authors: S
authors: Thevenet
authors: Claire
authors: C
authors: Boberie-Moyrand
authors: Gaëlle
authors: G
authors: Piccin
authors: Marie-Pierre
authors: MP
authors: Fernandez
authors: René-Charles
authors: RC
authors: Rudigoz
mesh_terms: D054869:Clinical Audit / Q000379:methods / Q000592:standards*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D017063:Outcome Assessment, Health Care; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic