Sunday, August 30, 2009

Perinatal Meeting

This week I was in Kampala for some meetings. The obstetrician I am working with here had invited me to his hospital in Kampala any Tuesday morning for perinatal conference, where they review the weekly morbidity and mortality (fetal and maternal). I love things like that – I always found it fascinating in residency – so I made a point of going while I was in Kampala.
The hospital is about 30 minutes away from where I was staying, and we left late, so I arrived about 20 minutes late. I missed the morning report, but got there just as the perinatal meeting was starting.

One intern presented each case briefly, and then another resident led the discussion about it, examining the cases critically. I liked the resident because she seemed to be demanding and strict, pointing out deficiencies honestly. Everyone was invited to participate, but they seemed to require prodding to speak up. The obstetrician who invited me spoke up often, asking details or pointing out missing information or problems. The resident then prompted the group to judge the management of each case as Optimal, Probably Acceptable, Probably Suboptimal, or Suboptimal. I wasn’t clear if these were considered ordinal (as in, Probably Suboptimal being less bad than Suboptimal) or if the “probably” referred to lack of clarity. All presentations were anonymous, and the group seemed to judge each case fairly.

After all of the prepared cases had been presented, the obstetrician pointed out several that had occurred during the week and chastised the residents for not having tracked down those charts. Last, the cases were listed again, and the group discussed whether there was a broader conclusion that could be drawn from these cases in order to make systemic improvements. This particular week, there was no consistency to the cases – most of them were macerated stillbirths (indicating that death of the fetus had occurred several days or more before presentation), but in previous weeks they had suggested improvements such as retraining of staff on neonatal rescusitation, and stricter regulations about obtaining syphilis tests prior to discharge home.
It was very enjoyable for me, both because it was nice to be hearing about obstetrics again, and also because it was a good example of honest internal review and non-punitive systems improvement. I hope I can attend more of these while I am here.

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