Richard F, Ouédraogo C, Zongo V, Ouattara F, Zongo S, Gruénais M E, De Brouwere V
Quality and Human Resources Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
BJOG. 2009 Jan;116(1):38-44. doi: 10.1111/j.1471-0528.2008.01741.x. Epub 2008 May 22.
To describe the implementation of facility-based case reviews (medical audits) in a maternity unit and their effect on the staff involved.
Cross-sectional descriptive study.
A 26-bed obstetric unit in a district hospital in Ouagadougou, Burkina Faso.
Sixteen audit sessions conducted between February 2004 and June 2005. Thirty-five staff members were interviewed.
An analysis of all the tools used in the management of the audit was performed: attendance lists, case summary cards and register of recommendations. The perceptions of the staff about the audits were collected through a questionnaire administrated by an external investigator from 10 June 2005 to 16 June 2005.
Session participation, types of problems identified, recommendations proposed and implemented and staff reaction to the audits.
Only 7 midwives from a total of 15 regularly attended the sessions. Eighty-two percent of the recommendations made during the audits have been implemented, but sometimes after a delay of several months. Interviewed personnel had a good understanding of the audit goals and viewed audit as a factor in changing their practice. However, midwives highlighted problems of bad interpersonal communication and lack of anonymity during the audit sessions, and pointed out the difficulty of practising self-criticism.
A lack of staff commitment and the resistance of maternity personnel to being evaluated by their peers or service users are reducing acceptance of routine audits. The World Health Organization must take all these factors into account when promoting the institutionalisation of medical audits in obstetrics.
描述在一个产科病房实施基于机构的病例审查（医学审计）及其对相关工作人员的影响。
横断面描述性研究。
布基纳法索瓦加杜古一家地区医院的一个拥有26张床位的产科病房。
2004年2月至2005年6月期间进行的16次审计会议。对35名工作人员进行了访谈。
对审计管理中使用的所有工具进行分析：出勤名单、病例总结卡和建议登记簿。通过一名外部调查员于2005年6月10日至2005年6月16日发放的问卷收集工作人员对审计的看法。
会议参与情况、发现的问题类型、提出并实施的建议以及工作人员对审计的反应。
总共15名助产士中只有7名定期参加会议。审计期间提出的建议中有82%已得到实施，但有时会延迟数月。接受访谈的人员对审计目标有很好的理解，并将审计视为改变其做法的一个因素。然而，助产士强调了审计会议期间人际沟通不良和缺乏匿名性的问题，并指出了进行自我批评的困难。
工作人员缺乏投入以及产科人员抵制由同行或服务使用者进行评估，这降低了对常规审计的接受度。世界卫生组织在推动产科医学审计制度化时必须考虑所有这些因素。
