Perinatal mortality audits and reporting of perinatal deaths: systematic review of outcomes and barriers.

BACKGROUND: Perinatal deaths are a devastating experience for all families and healthcare professionals involved. Audit of perinatal mortality (PNM) is essential to better understand the factors associated with perinatal death, to identify key deficiencies in healthcare provision and should be utilised to improve the quality of perinatal care. However, barriers exist to successful audit implementation and few countries have implemented national perinatal audit programs. CONTENT: We searched the PubMed, EMBASE and EBSCO host, including Medline, Academic Search Complete and CINAHL Plus databases for articles that were published from 1st January 2000. Articles evaluating perinatal mortality audits or audit implementation, identifying risk or care factors of perinatal mortality through audits, in middle and/or high-income countries were considered for inclusion in this review. Twenty articles met inclusion criteria. Incomplete datasets, nonstandard audit methods and classifications, and inadequate staff training were highlighted as barriers to PNM reporting and audit implementation. Failure in timely detection and management of antenatal maternal and fetal conditions and late presentation or failure to escalate care were the most common substandard care factors identified through audit. Overall, recommendations for perinatal audit focused on standardised audit tools and training of staff. Overall, the implementation of audit recommendations remains unclear. SUMMARY: This review highlights barriers to audit practices and emphasises the need for adequately trained staff to participate in regular audit that is standardised and thorough. To achieve the goal of reducing PNM, it is crucial that the audit cycle is completed with continuous re-evaluation of recommended changes.

National perinatal mortality audits and resultant initiatives in four countries.

BACKGROUND: It is important to examine perinatal deaths as part of a national mortality audit to identify risk factors. Implementing and re-evaluating recommendations from perinatal mortality audits completes the audit cycle, preventing similar deaths in the future. Lack of implementation results in recommendations recurring. OBJECTIVES: In this study we examine national perinatal mortality audits' methodology in four high-income countries (United Kingdom, New Zealand, Ireland, Netherlands) to highlight different approaches taken. We compare the recommendations made in these audits' reports over the last five years, as well as review national initiatives and programmes addressing them. STUDY DESIGN: This study is an integrative review where two comprehensive literature searches were completed: on established national perinatal mortality audits in high-income countries; and on national initiatives addressing recommendations from these audits. Content analysis of the audits' recommendations was performed organising them into themes according to topics these focused on. RESULTS: Though the methodology of the national perinatal mortality audits varied, all four were state-funded and had standardised online data collection forms to report deaths. The recommendations themes included: Raising public awareness of perinatal mortality risk factors, Detection of fetal growth restriction, Prevention of preterm birth, Resources for data collection and review. Only the UK had various initiatives addressing perinatal mortality risk factors directly. New Zealand included stakeholders in the audit recommendations' development and provided updates on their implementation. The Netherlands developed a programme for audit recommendation implementation. Ireland created a group which is progressing some recommendations from the audit. CONCLUSIONS: National perinatal mortality audits are important in identifying contributory factors and making recommendations to address these. Recurring recommendations suggest a failure to resolve the identified issues. This study shows how some challenges are common to high-income countries' audits, highlighting the need for shared learning of successful initiatives.

Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic.

The COVID-19 pandemic has had a tremendous effect on education programs worldwide, including medical education. Particularly, International Medical Graduates (IMGs) planning to pursue residency training in Canada have been profoundly impacted. Cancellation of away electives, as well as changes to the format, timeline, and requirements of mandatory medical licensing exams has left IMG residency applicants in uncharted territory. Given that IMGs comprise up to 25% of the Canadian healthcare force, and often are based in underserviced areas, the licensure and eligibility of IMGs to continue to enter the Canadian healthcare force is of the utmost importance in the midst of the COVID-19 pandemic. As the pandemic evolves, it is imperative that key decision makers and stakeholders continue to consider the downstream effect for IMGs and their eligibility to practice in Canada.

La pandémie de la COVID-19 a fortement affecté les programmes d'éducation dans le monde entier, y compris l'éducation médicale. En particulier, les diplômés internationaux en médecine (DIM) qui prévoyaient s'inscrire à un programme de résidence au Canada ont été profondément touchés. L'annulation des stages à l'étranger, ainsi que les changements apportés au format, au calendrier et aux exigences des examens requis pour l'obtention du permis d'exercice de la médecine ont laissé en territoire inconnu les candidats internationaux aux programmes de résidence. Étant donné que les DIM représentent jusqu'à 25 % des professionnels de la santé au Canada et qu'ils exercent souvent dans les régions mal desservies, l'octroi de permis d'exercice et le recrutement de DIM dans le réseau de la santé canadien revêtent une importance capitale en contexte de pandémie de la COVID-19. À mesure que la pandémie évolue, il est impératif que les principaux décideurs et intervenants continuent de tenir compte des effets néfastes qu'elle peut avoir pour les DIM et leur admissibilité à l'exercice de la profession au Canada.