Abstract
Objective – audit of departmental compliance with the Royal College of Obstetrics and Gynaecology (RCOG) minimum attendance
requirements for Consultant Obstetricians as detailed in the 2022 update of their “Roles and Responsibilities” guidance.
Design – retrospective clinical audit.
Setting – small (2000 delivery/annum) Consultant-led maternity unit in the North East of England.
Population or Sample – all eligible cases in Tables 1 and 2 of the RCOG guidance (Appendix 1) for the period April to September 2022.
Methods – quantitative case note review, qualitative review of cases linked to outcome/patient experience, triangulation of cases
against patient safety incidents reported.
Main Outcome Measures –
• Primary outcome – Consultant presence (Table 1 cases), evidence of competency of most senior obstetrician present (Table 2 cases).
• Secondary outcomes – reason Consultant not present, impact on patient outcomes.
Results – there were 36 eligible cases for Table 1 indications with a compliance rate of 94%, and 57 eligible cases for Table 2 with
a compliance rate of 84%. There were 7 post-partum haemorrhages when the Consultant was not in attendance. 1 non-compliant
case correlated with a significant patient complaint. There were no reported occasions when a Consultant had refused to attend when
requested.
Conclusions
• There were high levels of compliance with both RCOG tables.
• There was theme of non-attendance at post-partum haemorrhage events (both >2000ml and >1500ml). This was explored further
and themes identified included the total blood loss not being calculated until the situation was under control thereby missing the
opportunity to escalate, lack of awareness of trainee competency.
• Opportunities for further awareness work for PPH – earlier measurement/assessment/escalation, clarity of role of post-CCT clinicians
when functioning as part of the trainee rota, psychological safety of who needs to be aware of individual competencies – rotating
trainees and locum staff, explore the potential for regional/Deanery standardised process for recording competency and sharing
records.
• Funding – this student is funded by the apprenticeship levy, Chartered Management Institute.
• Keywords – Consultant roles and responsibilities, Safety Action 4, Maternity Incentive Scheme, competency.
• Tweetable abstract – overall compliance with Obstetric Consultant attendance at RCOG specified clinical scenarios is good however
transparency of trainee and locum competency levels and loss of situational awareness can lead to missed opportunities to escalate.