Quality assurance: measures of maternal knowledge and satisfaction.

This paper reviews the introduction and results of an Outcome Assessment system developed to determine if all women delivering at the Royal Women's Hospital, Brisbane were receiving an acceptable level of care. The system involves measurement of four outcome variables: nosocomial infection rate; medication error rate; accident rate; and a comprehensive patient questionnaire. Scores are combined and a monthly Quality of Care Score, and other information including the Caesarean delivery rate, bed occupancy rate, number of primiparas in the ward and percentage of women who failed to achieve a minimum acceptable score, is prepared for each ward. On another level, the system allows midwives to objectively evaluate the care provided in their ward by involving each patient's primary midwife, clinical nurse consultant and unit manager in the collection and review of data. The monthly feedback to wards, the Director of Nursing, Chief Executive Officer, Dietitian and Senior Domestic Supervisor has resulted in changes which had previously been difficult to achieve.