This audit evaluated the completion of gynae emergency clerking proformas at the United Lincolnshire Hospitals Trust (ULHT) to assess documentation quality for emergency patients. Data was collected from January 1 to February 28, 2023, for the two hospitals under this trust, with 39 and 50 available patient notes from them. The audit measured compliance against standards including patient identification, documentation of location, date, time of arrival, admitting consultant, source of referral, observations, past medical history, medications, examination findings, condition impression, initial management plan, VTE assessment, and the signature of the clerking doctor. Results indicated significant deficiencies: 34% and 46% of proformas lacked a doctor's signature in hospital A and hospital B, respectively; 34% and 44% had incomplete VTE assessments; 16% and 15% were missing initial observations; and 64% and 51% did not document the time of arrival. Patient identification was incomplete, documented only on the front page in 86% of hospital A and 59% of hospital B cases. The audit concluded that complete and accurate proforma completion is critical for patient safety and recommended enhancements to the induction process, potential revision of the proforma, and re-auditing to monitor improvements. The audit underscores the need for improved training and procedural adjustments to ensure comprehensive documentation.

Dr. Ejaz and Dr. Akram are currently practicing in obstetrics and gynecology at the United Lincoln Hospital Trust in the UK. Both physicians obtained their MBBS degrees in Pakistan before relocating to the UK to specialize in women's health. Dr. Akram successfully obtained her MRCOG certification in 2021, while Dr. Ejaz has completed the first part of his MRCOG. They are both enthusiastic about furthering their training and advancing their careers in gynecology and obstetrics. Engaged in numerous quality improvement initiatives and audits, their primary objective is to enhance the standard of care provided to their patients.