Improved obstetric safety through programmatic collaboration

Abstract

Healthcare safety and quality are critically important issues in obstetrics, and society, healthcare providers, patients and insurers share a common goal of working toward safer practice, and are continuously seeking strategies to facilitate improvements. To this end, 4 New York City voluntary hospitals with large maternity services initiated a unique collaborative quality improvement program. It was facilitated by their common risk management advisors, FOJP Service Corporation, and their professional liability insurer, Hospitals Insurance Company. Under the guidance of 4 obstetrics and gynecology departmental chairmen, consensus best practices for obstetrics were developed which included: implementation of evidence based protocols with audit and feedback; standardized educational interventions; mandatory electronic fetal monitoring training; and enhanced in-house physician coverage. Each institution developed unique safety related expertise (development of electronic documentation, team training, and simulation education), and experiences were shared across the collaborative. The collaborative group developed robust systems for audit of outcomes and documentation quality, as well as enforcement mechanisms. Ongoing feedback to providers served as a key component of the intervention. The liability carrier provided financial support for these patient safety innovations. As a result of the interventions, the overall AOI for our institutions decreased 42% from baseline (January-June 2008) to the most recently reviewed time period (July-December 2011) (10.7% vs 6.2%, p < 0.001). The Weighted Adverse Outcome Score (WAOS) also decreased during the same time period (3.9 vs 2.3, p = 0.001.) Given the improved outcomes noted, our unique program and the process by which it was developed are described in the hopes that others will recognize collaborative partnering with or without insurers as an opportunity to improve obstetric patient safety.

The Effect of Multiprofessional Simulation-Based Obstetric Team Training on Patient-Reported Quality of Care

“…16,17 Furthermore, Crofts et al 12 showed that multiprofessional simulation-based obstetric training improved perceived quality of care, although this was reported by patient-actors instead of real patients. Previous research showed that multidisciplinary team training in crew resource management (CRM) results in positive reactions among trainees.…”

The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

“…Other studies have examined the impact of CTG education on neonatal outcomes, most of them in the context of other interventions and most finding no effect on low pH values or Apgar score . The implementation of the Fetal Surveillance Education Program in Australia was associated with a decrease in incidence of hypoxic ischemic encephalopathy .…”

Position-related injury is uncommon in robotic gynecologic surgery

“…Standardized protocols have been shown to decrease medical errors, iatrogenic injury and improve patient outcomes across a broad range of medical specialties (13–15). All of the patients in our study were cared for by an experienced team of nurses, operating room technicians and physicians who used a standardized approach to patient positioning.…”