We have not done many columns on patient safety in obstetrics and gynecology. Our September 7, 2010 Patient Safety Tip of the Week “Inducing Too Early”).” highlighted several programs and recently we wrote about too many early labor inductions (see our February 8, 2011 Patient Safety Tip of the Week “
In the last month there have been three publications about comprehensive ob/gyn patient safety programs. Interventions included team training, simulation, use of evidence-based protocols, and electronic fetal monitoring certification programs, among other programs. One (Wagner 2011) used the modified Adverse Outcome Index (MAOI) to monitor adverse events and documented significant and sustained reductions in the MAOI. Another (Grunebaum 2011) showed a dramatic reduction in sentinel events from 5 per year to none and (malpractice) compensation payments dropped from an average of $27M per year down to $ .5M per year. The third (Shannon 2011) also demonstrated both improvements in the Adverse Outcome Index and a reduction in malpractice claims. One insurer reduced malpractice premiums for obstetricians who participated in the training program. The latter provides good stories about how the teamwork training developed at one institution spilled over to multiple institutions and other departments.
These programs shared many features in common with the MOREOB Program (see our September 7, 2010 Patient Safety Tip of the Week “focused on communication and teamwork building, skill building, culture of safety, emergency skill drills, education, and use of patient safety tools like RCA, FMEA, near miss reviews, audits, etc. That program has reduced NICU admissions and resulted in fewer neonates with respiratory distress, sepsis, CNS hemorrhage, and a variety of other neonatal and maternal outcomes. ”) that
In addition to the improvements in safety of obstetrical care, there were numerous other valuable benefits of the teamwork training. The Shannon article discusses how the teamwork training led to staff better dealing with conflict and disruptive behavior.
Grunebaum A, Chervenak F, Skupski D. Effect of a comprehensive obstetric patient safety program on compensation payments and sentinel events. Review Article.
Am J Obstet & Gynecol 2011; 204(2): 97-105
Wagner B, Meirowitz N, Shah J, et al. Comprehensive Perinatal Safety Initiative to Reduce Adverse Obstetric Events. Journal of Healthcare Quality 2011; published online March 1, 2011
Shannon D. Obstetrical Team Training: How the Response to a Tragic Event Revolutionized Care Across the Country. Physician Executive Journal 2011; March•april/2011 pp. 4-11