title: Measuring pregnancy care: towards better maternal and child health.
abstract: BACKGROUND
  Obstetrics remains the largest medico-legal liability in healthcare. Neither an increasing awareness of patient safety nor a long tradition of reporting obstetric outcomes have reduced either rates of medical error or obstetric litigation. International debate continues about the best approaches to measuring and improving patient safety. In this study, we set out to assess the feasibility and utility of measuring the process of maternity care provision rather than care outcomes.
  
  
  OBJECTIVE
  To report the development, application and results of a tool designed to measure the process of maternity care.
  
  
  METHODS
  A dedicated audit tool was developed, informed by local, national and international standards guiding best practice and then applied to a convenience sample of individual healthcare records as proof of function. Omissions of care were rated in order of severity (low, medium or high) based on the likelihood of serious consequences on patient safety and outcome.
  
  
  RESULTS
  The rate of high severity omissions of care was less that 2%. However, overall rates of all omissions varied from 0 to 99%, highlighting key areas for clinical practice improvement.
  
  
  CONCLUSIONS
  Measuring process of care provision, rather than pregnancy outcomes, is feasible and insightful, effectively identifying gaps in care provision and affording opportunities for targeted care improvement. This approach to improving patient safety, and potentially reducing litigation burden, promises to be a useful adjunct to the measurement of outcomes.
authors: Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.|Monash Women's Services, Monash Health, Clayton, Victoria, Australia.
authors: Suzanne V
authors: SV
authors: Sinni
authors: School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors: Wendy M
authors: WM
authors: Cross
authors: Monash Women's Services, Monash Health, Clayton, Victoria, Australia.
authors: Amy E
authors: AE
authors: Swanson
authors: Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.|Monash Women's Services, Monash Health, Clayton, Victoria, Australia.
authors: Euan M
authors: EM
authors: Wallace
mesh_terms: D000293:Adolescent; D000328:Adult; D004282:Documentation / Q000592:standards; D005260:Female; D006801:Humans; D000068104:Infant Health; D000068097:Maternal Health; D008485:Medical Audit; D019300:Medical Errors / Q000517:prevention & control*; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011295:Prenatal Care / Q000592:standards*; D017064:Process Assessment, Health Care / Q000379:methods; D055815:Young Adult
keywords: clinical audit; clinical error; patient safety; pregnancy care