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Does consultant obstetrician presence on the labour ward (LW) improve quality of patient care? a review of quality indicators at royal Bolton hospital
  1. N Katakam,
  2. D Chan,
  3. T Rockett,
  4. S Wong,
  5. S Das
  1. Royal Bolton Hospital, Bolton, United Kingdom

Abstract

Introduction The impetus to increase the consultant obstetrician presence on LW resulted from growing concerns regarding patient safety highlighted by various national audits. It was deemed that women would benefit from improved care and fewer interventions while Trusts benefit from less litigation, fewer complaints and reduction in the cost of indemnity.

Objectives Identify and use indicators to assess improvement in quality of care 2 years before and after introduction of consultant presence on LW. We used SMART (Specific–Measurable–Achievable–Realistic-Time-bound) criteria to select our indicators.

Method Indicators used

Prospective data-collection (Questionnaires)

Patient

Midwives

Junior doctors

Obstetric interventions (Retrospective-data)

Operative deliveries/related complications

Complaints/litigations/cost of indemnity

Results Patients were reviewed more often by the Consultant and 87% had positive birth experience. 94% of the midwives felt that the consultant presence was useful in management of complex cases and when there was high volume of work. 90% of trainees across the deanery agreed that consultant presence improved training and quality of care. More procedures were supervised by Consultants with significant reduction in emergency Caesarean section and post-partum haemorrhage rates. There was a substantial reduction in claims. Detailed results will be presented at the Conference.

Conclusions The data shows that Consultant's presence on LW enhances patient satisfaction and quality of care. It strengthens trainee experience and boosts staff morale. The study is limited by the retrospective nature of the data. We call on the RCOG to refine the quality and performance indicators used in our study to develop a standardised National data-set to measure quality of obstetric care.

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