Audit and Feedback

The audit concerns several medical records, and as an output, it provides a conclusive analysis that will be presented to the rest of the medical staff (feedback)

The audit involves the analysis of medical practices by the practitioners themselves (physicians, nurses/midwives) according to the evidence-based clinical protocols selected by the providers in each facility and subsequent advice as to whether the decision for caesarean section was the most appropriate.

The Audit is monthly implemented by OLs and their collaborators in 8 steps:

  • Classify all women who delivered in the participating facility into the ten groups of the Robson classification
  • Select medical records of low-risk women (groups 1 to 4 of Robson’s classification*) with caesarean section.
  • Review caesarean section indications according to evidence-based clinical protocol
  • Enter data on a secure web-based system
  • Results are summarized into the maternity dashboard (provided by the web-based system)
  • Feedback of results to healthcare providers
  • Recommendations for action (to avoid unnecessary caesarean sections)
  • Assess wether recommandations have been implemented

This will help the project to adapt and stay flexible in order to create a QUALI-DEC plan tailored to each context.

*The Robson’s classification, also known as the Ten-Group Classification System (TGCS), is used to group the different cases of pregnancy in a given hospital according to their risk of enduring a cesarean section. This classification regroups pregnancies based on their caracteristics.
WHO proposes to adopt the TGCS system as an international reference system for the evaluation, monitoring and comparison of caesarean section rates within and between health care facilities over time.
Learn more about the TGCS

More ressources for audit & feedback and how to implement it:
Clinical algorithms