Quality assurance in obstetric ultrasound.

Ultrasound examination is a routine element of antenatal care, and an accurate and reliable ultrasound service is essential for confident patient management. Qualitative findings, e.g. fetal normality and placental site, may be confirmed at delivery, but this form of audit is not suitable for fetal measurements owing to the variation in gestation at delivery and the complexity of neonatal assessment. Our aim was to develop a simple audit method applied a short time after the ultrasound scan. The method was based on assessment of measured images against measurement criteria which are clearly defined in the literature, results for each criterion being recorded in a spreadsheet. Two main forms of report were generated, the first showing overall achievement of satisfactory measurements for each sonographer, the second providing graphical information to show which criteria required greater attention by individual sonographers. Over several phases of audit problems of quality recognition and technical skill were isolated, graphical reports were used to guide tuition and the levels of performance were improved. The method itself and the results satisfy managers at all levels that standards are in place and are being maintained.