The Leeds University maternity audit project

Wilson, Barbara L.; Thornton, Jim; Hewison, Jenny; Lilford, Richard; Watt, Ian; Braunholtz, David; Robinson, Mary

doi:10.1093/oxfordjournals.intqhc.a002609

Cited by 37 publications

(38 citation statements)

References 12 publications

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“…In Thailand, registered nurses with midwifery training usually provide the routine obstetric care. In Thai hospitals, the median number of doctors was 6 (range 3-18) and 5 (2-11) in the intervention and control groups respectively, and the number for nurses were 15 (10-28) and 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), respectively. The trial workshops were successfully implemented although the implementation of health sector reform initiatives in Thailand resulted in a prolonged interval (up to 6 months in some) interval between the second and third workshops.…”

Section: Resultsmentioning

confidence: 99%

“…A retrospective analysis of obstetric practices in the UK showed substantial shifts over a period of 8 years, although it is not clear when the change took place. 13 There were various barriers, including language in Thailand, that may have contributed to the lack of effect, some of them beyond hospital clinical staff's control 14 . Since our intervention targeted primarily clinical staff, some institutional and other organisational barriers, whether perceived or real, may have impeded change.…”

Section: Discussionmentioning

confidence: 99%

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Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices

Gülmezoglu

Langer

Piaggio

et al. 2006

BJOG

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Objective We conducted a trial to evaluate the effect of an active, multifaceted educational strategy to promote the use of the WHO Reproductive Health Library (RHL) on obstetric practices.Design Cluster randomised trial. The trial was assigned the International Standardised Randomised Controlled Trial Number ISRCTN14055385.Settings Twenty-two hospitals in Mexico City and 18 in the Northeast region of Thailand.Methods The intervention consisted primarily of three interactive workshops using RHL over a period of 6 months. The focus of the workshops was to provide access to knowledge and enable its use. A computer and support for using both the computer and RHL were provided at each hospital. The control hospitals did not receive any intervention.Main outcome measures The main outcome measures were changes in ten selected clinical practices as recommended in RHL starting approximately four to six months after the third workshop. Clinical practice data were collected at each hospital from 1000 consecutively delivered women or for a 6-month period whichever was reached sooner.Results The active, multifaceted educational intervention we employed did not affect the ten targeted practices in a consistent and substantive way. Iron/folate supplementation, uterotonic use after birth and breastfeeding on demand were already frequently practiced, and we were unable to measure external cephalic version. Of the remaining six practices, selective, as opposed to routine episiotomy policy increased in the intervention group (difference in adjusted mean rate = 5.3%; 95% CI -0.1 to 10.7%) in Thailand, and there was a trend towards an increased use of antibiotics at caesarean section in Mexico (difference in adjusted mean rate = 19.0%; 95% CI: -8.0 to 46.0%). There were no differences in the use of labour companionship, magnesium sulphate use for eclampsia, corticosteroids for women delivering before 34 weeks and vacuum extraction. RHL awareness in Mexico and 15.5-76.4% in Thailand) increased substantially after the intervention in both countries. ConclusionThe multifaceted, active strategy to provide health workers with the knowledge and skills to use RHL to improve their practice led to increased access to and use of RHL, however, no consistent or substantive changes in clinical practices were detected within 4-6 months after the third workshop. The WHO Reproductive Health Library (RHL) is an annually updated electronic publication. 1 It includes predominantly Cochrane systematic reviews in reproductive health together with commentaries written by experts on the topic and familiar with under-resourced settings, short practical guidance documents, and implementation aids (such as educational videos) to facilitate the adoption of evidence-based practices. RHL is published in English and Spanish with new topics 16 ª

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices

Gülmezoglu

Langer

Piaggio

et al. 2006

BJOG

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“…A study of 20 UK maternity units found substantial change in practise over 8 years, but few associations between proxy outcomes and other explanatory variables. 49 Earlier in this phase of the study, we considered the beneits and limitations of using case notes as the basis for reviewing quality of care and examined the reliability and value of two review methods -holistic (implicit) review and criterionbased (explicit) review -in the hands of different types of health professional. We showed that the two methods provide different types of quality assessment with reasonable to good levels of reliability.…”

Section: Introductionmentioning

confidence: 99%

Comparison of case note review methods for evaluating quality and safety in health care

Hutchinson

Coster²,

Cooper³

et al. 2010

Health Technol Assess

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Article:Hutchinson, A., Coster, J.E., Cooper, K.L. et al. (8 more authors) (2010) Comparison of case note review methods for evaluating quality and safety in health care. Health Technology Assessment, 14 (10). pp. 1-170. ISSN 1366-5278 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. 2010; Vol. 14: No. 10 Health Technology Assessment NIHR HTA programme www.hta.ac.uk How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below). Health Technology AssessmentPrinted copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during ofice hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address. Paying by credit cardYou can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume. How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Te...

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“…Such improvements might be partly attributable to wider acceptance of their evidence base. 16 Thus, our ability to produce or detect significant improvements in practice was limited by 'ceiling effects' for two important outcomes, encountered by other investigators. 17 Other potential design weaknesses are unlikely to account for the lack of effect.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of a tailored multifaceted strategy to promote implementation of a clinical guideline on induced abortion care

Foy

Penney

Grimshaw

et al. 2004

BJOG

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Objective To evaluate the effectiveness and efficiency of a tailored multifaceted strategy, delivered by a national clinical effectiveness programme, to implement a guideline on induced abortion. Design Cluster randomised controlled trial.Setting and participants All 26 hospital gynaecology units in Scotland providing induced abortion care.Intervention Following the identification of barriers to guideline implementation, intervention units received a package comprising audit and feedback, unit educational meetings, dissemination of structured case records and promotion of a patient information booklet. Control units received printed guideline summaries alone. Main outcome measures Compliance with five key guideline recommendations (primary outcomes) and compliance with other recommendations, patient satisfaction and costs of the implementation strategy (secondary outcomes). Results No effect was observed for any key recommendation: appointment with a gynaecologist within five days of referral (odds ratio 0.89; 95% confidence interval 0.50 to 1.58); ascertainment of cervical cytology history (0.93; 0.36 to 2.40); antibiotic prophylaxis or screening for lower genital tract infection (1.70; 0.71 to 5.99); use of misoprostol as an alternative to gemeprost (1.00; 0.27 to 1.77); and offer of contraceptive supplies at discharge (1.11; 0.48 to 2.53). Median pre-intervention compliance was near optimal for antibiotic prophylaxis and misoprostol use. No intervention benefit was observed for any secondary outcome. The intervention costs an average of £2607 per gynaecology unit. Conclusions The tailored multifaceted strategy was ineffective. This was possibly attributable to high preintervention compliance and the limited impact of the strategy on factors outside the perceived control of clinical staff.

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The Leeds University maternity audit project

Cited by 37 publications

References 12 publications

Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices

Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices

Comparison of case note review methods for evaluating quality and safety in health care

A randomised controlled trial of a tailored multifaceted strategy to promote implementation of a clinical guideline on induced abortion care

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