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Issue 478, 4 March 2002

Study exposes substandard NHS care

Around 200 babies are dying each year and thousands of women suffering pain following childbirth, because doctors in maternity wards are still using outdated practices.

A study by obstetrics and gynaecology researcher Dr Jim Thornton and colleagues at Leeds, York and Birmingham has found that despite clear scientific evidence showing best practice, many units had no systematic procedures for ensuring that guidelines were followed.

The study looked at cases from 1988 and 1996 in 20 maternity units to determine changes in practice. All cases involved four situations where a particular treatment was recommended.

Dr Jim Thornton explains: "We found a dramatic rise in the level of compliance, showing that obstetricians and midwives have altered their practice in response to evidence. However, adherence rates are still below 100 percent in many units, and in some units considerably below. As a result, large numbers of women and babies are receiving substandard care in the NHS."

The study estimates that each year 2,000 women suffer wound infections following Caesareans, 200 premature babies die, nearly 8,000 women are left in pain from catgut sutures and there are 1,500 cases of severe maternal trauma from forceps deliveries, and all of these are easily preventable if proper guidelines were followed.

Where guidelines were followed, the study found it was due to key enthusiastic staff, or access to the Cochrane database which reviews the results of clinical trials to help doctors keep up to date with new findings (for more information on Leeds' involvement in the Cochrane collaboration, see pages 4-5).

Dr Thornton: "Our study shows that clinicians do respond to the evidence, albeit imperfectly. Clearly there remains substantial room for improvement."

The study will be published in June in the International Journal for Quality in Health Care.

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