Promoting accountability in obstetric care: use of criteria-based audit in Viet Nam.

Audits can improve clinical and managerial practices, enhance the rational use of limited resources, and improve staff morale and motivation. Staff at five hospitals in Thanh Hoa and Quang Tri provinces (Viet Nam) used criteria-based audit (CBA) as a tool to improve the quality of emergency obstetric and newborn care. CBA compares current practice with standards based on the best available evidence and the local context. The audit cycle begins with a known problem, proceeds with an initial assessment and data collection, analysis of those data, formulation and implementation of an action plan, and a re-evaluation of the topic initially assessed. Teams found that clinical protocols for treating major obstetric complications were not followed, although, national guidelines had been issued in 2002. In an audit of facility organisation, staff addressed obstacles to the timely treatment of obstetric emergencies during off hours. In each audit, teams devised mechanisms to correct problems that resulted in significant improvements when the audit cycle was repeated. CBA improved adherence to national guidelines, improved record-keeping, heightened teamwork, and showed staff that they could identify and solve many of their own problems.