Quality assurance in obstetrics: a model.

Since 1985, a computerized data base has been used for the entry of information relevant to each of the 2500 deliveries performed at Danbury Hospital each year. This data base consists of 73 fields and codes for approximately 490 potential diagnoses and pieces of information spanning the patient's medical, surgical, and obstetric history; current antepartum, labor, delivery, and postpartum course; and neonatal course and outcome. With the publication of the Joint Commission on Accreditation of Healthcare Organizations Potential Obstetrical Care Clinical Indicators and, more recently, The American College of Obstetricians and Gynecologists (ACOG) Obstetric Clinical Indicators, information has been extracted from this data base and is being used as part of the quality assurance program of the department. The report generated from this extracted data base provides information regarding 22 of the 24 relevant ACOG indicators. The records thus identified are then subjected to an initial screen. Those records that do not pass the initial screen are reviewed by the departmental Patient Care Review Committee, which examines each record for suitability of management and has the ability to request clarification of that management from the responsible attending physician and/or to refer the record to the departmental chairman for further discussion with the attending physician. Topics for departmental educational programs can be based on deficiencies highlighted by the quality assurance program.