The quality of care given to sick children in hospital can be improved if there is a system for reviewing the outcomes of each child admitted to the hospital. At a minimum, the system should keep records of all children who died in the hospital. Trends in case fatality rates over time can then be compared, and the treatment given can be discussed by all staff with the aim of identifying any problems and finding solutions. Clinical audit meetings to discuss near-death events or deaths in children, especially those in which some aspect of treatment might have gone wrong, can also be helpful. The aim is to improve care and solve problems, not to attribute blame for errors.
An audit of hospital paediatric care can be carried out by comparing the quality of care actually given with a recognized standard, such as the WHO recommendations contained in this Pocket book. A successful audit calls for full, constructive participation of all medical and nursing staff. The audit should be simple and not take up too much of the time required for caring for sick children. One suggestion is to ask medical and nursing staff for their views on improving the quality of care and to give priority to the conditions or problems they identify.