Penney G C, Glasier A, Templeton A
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital.
BMJ. 1994 Jul 2;309(6946):15-9; discussion 18-9. doi: 10.1136/bmj.309.6946.15.
To assess and improve the quality of care provided to women undergoing induced abortion.
Two rounds of prospective, criterion based case note review audit.
Ten NHS gynaecology units throughout Scotland.
2004 patient episodes of abortion care identified consecutively during two rounds of audit. The first round comprised 967 cases and the second round 1037.
Dissemination of results from the first round of audit and recommendations for change in the form of a written report and at postgraduate meetings in participating hospitals.
Improvements in quality of care as assessed against 16 previously agreed criteria, both overall across the 10 study hospitals and within individual hospitals.
Overall, four significant improvements occurred: increased availability of early medical abortion, decreased utilisation of surgical abortion at very early gestation, increased use of mifepristone priming before second trimester medical abortion, and increased provision of follow up. At the individual hospital level 42 of 150 elements of care studied were "close to optimal" at the time of the first round of audit, rising to 54 at the second round (NS). A total of 31 significant improvements in individual elements of care occurred, but 11 significant deteriorations also occurred (at the P < 0.05 level).
The prospective multicentre audit proved feasible and achieved the aims of any form of audit in terms of identifying deficiencies and variations in care. The audit results prompted objective review of local abortion services in participating hospitals. At least for some elements of care in some hospitals significant improvements were detectable.
评估并改善为接受人工流产的女性提供的护理质量。
两轮基于标准的前瞻性病例记录回顾审计。
苏格兰各地的10个国民保健服务（NHS）妇科单位。
在两轮审计中连续识别出的2004例流产护理患者病例。第一轮包括967例，第二轮包括1037例。
以书面报告形式并在参与医院的研究生会议上传播第一轮审计结果及改进建议。
根据16项先前商定的标准评估护理质量的改善情况，包括10家研究医院整体以及各医院内部的情况。
总体而言，出现了四项显著改善：早期药物流产的可及性增加、极早期妊娠时手术流产的使用率降低、孕中期药物流产前米非司酮预处理的使用增加以及随访服务的提供增加。在第一轮审计时，所研究的150项护理要素中有42项“接近最佳”，第二轮升至54项（无显著性差异）。护理个别要素总共出现了31项显著改善，但也出现了11项显著恶化（P<0.05水平）。
前瞻性多中心审计证明是可行的，并且在识别护理缺陷和差异方面实现了任何形式审计的目标。审计结果促使对参与医院的当地流产服务进行客观审查。至少在某些医院的某些护理要素方面可检测到显著改善。
