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This book helps all those working in maternity services to improve the quality of the care they offer. Improvement is driven by clinical effectiveness and increasing patient demands, and for each area of practice described this book outlines the service organisation needed to achieve this improvement. The goal is to help clinicians take responsibility for developing services that meet the needs of their patients as well as managing their individual medical conditions. The book demonstrates that much can be achieved within current resources and without major additional expense. Different approaches are demonstrated, but the key issue is the patient pathway. Trainees, clinicians, managers and commissioners of services will find this book of practical value. There should be a copy on the shelves of every hospital obstetric unit.
The Royal College of Obstetricians and Gynaecologists (RCOG) published its document Standards in Maternity Care in 2008 which is being used widely by commissioners, providers and policy makers. The document sets out the principles of quality-assured maternity services. This chapter identifies some key indicators as exemplars, although it is recommended to make use of the whole document. Prepregnancy care for women with social needs is essential. Prepregnancy care can improve outcomes in high-risk pregnancies regardless of whether the high-risk status is of medical or social aetiology. From a public health perspective, the identification of anomalies can improve perinatal morbidity and mortality, as conditions may be identified early in pregnancy and managed accordingly. Current approaches for the prevention of hypoxic ischaemic encephalopathy include antenatal identification and monitoring of fetal growth restriction and electronic fetal monitoring accompanied by intrapartum fetal blood sampling.
The Royal College of Obstetricians and Gynaecologists (RCOG) published its document Standards for Gynaecology in 2008 and is being used widely by commissioners, providers and policy makers. It sets out the principles of quality assured gynaecological services. The recommendations cover issues such as gynaecological services, early pregnancy loss, ectopic pregnancy, recurrent miscarriage, infertility, urogynaecology, colposcopy, termination of pregnancy and laparoscopic surgery. All emotional and psychological counselling requirements should be provided within the early pregnancy assessment unit. All units should audit patient choice and uptake rates for medical, surgical and conservative management of miscarriage, together with complications and failure rates. Clear information on choice of anonymised testing, treatment and contact tracing through genitourinary medicine should be available. Counselling and advice on sterilisation procedures (both vasectomy and tubal occlusion) should be provided in the context of services providing a full range of information about and access to long-term reversible methods of contraception.
The purpose of setting standards for overall patient care is to address variations in care, to prevent inappropriate care and to address issues of inequity which have been reported in the past. The Royal College of Obstetricians and Gynaecologists (RCOG) takes a lead in developing evidence-based service standards to support local implementation protocols in all areas of gynaecological practice. Implementation of these standards should be supported by undertaking a constantly evolving audit cycle and by having multidisciplinary involvement to measure performance. The direction of travel of the National Health Service (NHS) is now for a patient-focused and quality-assured service, where patients' experience will influence service delivery models. The authors understand that professional bodies and NICE will be working together in developing a framework for service accreditation using some of the evidence used in their standards document.
This book helps to improve the quality of the care in gynaecological practice. Improvement is driven by clinical effectiveness and increasing patient demands, and for each area of practice described this book outlines the service organization needed to achieve this improvement. The goal is to help clinicians take responsibility for developing services that meet the needs of their patients as well as managing their individual medical conditions. The book demonstrates that much can be achieved within current resources and without the need for major additional expense. Different approaches are demonstrated but the key issue is the patient pathway, with the underlying philosophy of continuous improvement in quality. Trainees, clinicians, managers and commissioners of services in obstetrics and gynaecology will find this book of immense practical value.