Journal of the Royal Society of Medicine
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The maternal mortality rate was the first measure of quality in the obstetric services. It is a crude indicator but is still used for international comparisons. ⋯ The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have jointly published standards of care in labour wards. Gynaecological standards are less well developed but should evolve as NHS audit improves.
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This article seeks to discover and recognize the importance of clinical governance within a new and emerging quality National Health Service (NHS) system. It evaluates the present state of prehospital care and recommends how change, via clinical governance, can ensure a paradigm shift from its currently fragmented state to a seamless ongoing patient care episode. ⋯ A frank and open view of immediate care doctors is presented, with recommendations to improve the quality of skill delivery and reduce the disparity that exists. Finally, it reviews the current problems with pre-hospital care and projects a future course for quality and patient care excellence.