Methodological Issues Associated with an Audit of Stillbirth in a Family Medicine Practice in Israel

An audit of ‘deficient outcome’ involves the step-by-stepanalysis of every event preceding the occurrence of a preventablemedical outcome in order to determine exactly what went wrong.This paper describes methodological problems and related issuesassociated with a deficient outcome audit undertaken on fivestillbirths which occurred in a rural family medical practiceIsrael between 1985 and 1987. Problems included initial officialdisinterest towards the audit, and the high levels of suspicionand antagonism which it aroused in hospital staff approachedfor information. The problematic aspect of such audits needsmore attention. The importance of this type of audit for establishing the precisereasons for perinatal deaths, and thus for maintaining antenatalcare standards is discussed. In view of the small numbers ofsuch events likely to occur within any one family practice itis not only feasible but also desirable for more family doctorsto carry out such audits routinely, despite the difficultieswhich are involved.