In the Literature: Comprehensive patient safety program results in dramatic decrease in adverse events, 99% reduction in malpractice payments

This project was selected from among many reported in the peer reviewed literature. For a list of more articles on quality improvement, visit our resource bibliography.

Article citation

Grunebaum A, Chervenak F, Skupski D. Effect of a comprehensive obstetric patient safety program on compensation payments and sentinel events. Am J Obstet Gynecol. 2011;204(2):97-105. (abstract)

Project Description and Results

New York Presbyterian Hospital-Weill Cornell Medical Center, a tertiary academic referral center in New York City, reports that following a multi-year, comprehensive patient safety program, sentinel events (maternal deaths and serious newborn injuries) decreased from 5 in 2000 to none in 2008 and 2009 while yearly compensation payments decreased from more than $27 million between 2003 and 2006 to $2.5 million between 2007-2009, a 99% reduction that far offset the cost of implementing the safety program.

Elements of the integrated, comprehensive patient safety program included:

  • Interdisciplinary team training for all clinical and clerical staff
  • Electronic medical record documentation of all intrapartum care, with special templates for documenting shoulder dystocia, instrumental vaginal deliveries, and other clinical situations with high risk of injury and liability
  • Establishment of a chain of communication to ensure a quick resolution to unresolved and urgent issues
  • Addition of a dedicated gynecology attending, three physicians assistants, and night/weekend laborist to decrease stress on obstetric staff and accommodate reduced residency hours
  • A policy prohibiting use of misoprostol for cervical ripening, except in cases in which the fetus is nonviable
  • A standardized low-dose oxytocin protocol for induction and augmentation and several changes, such as premixed solutions and color-coded tubing, to ensure safe administration of oxytocin, magnesium sulfate, and other high-alert medications
  • A checklist for most important elements of the standardized oxytocin policy
  • Standardized training for electronic fetal monitoring and adoption of NICHD language for documenting fetal heart rate patterns
  • Obstetric emergency drills for situations including shoulder dystocia, maternal hemorrhage, and emergency cesarean section
  • Availability of postpartum hemorrhage kit including all four medications that might be administered to control a hemorrhage
  • Addition of a full-time patient safety nurse, responsible for team training, emergency drills, and data collection
  • Implementation of an electronic, online whiteboard to replace the typical dry-erase whiteboard used to communicate basic information about the clinical status of patients admitted to labor and delivery
  • Routine thromboembolism prophylaxis for women after cesarean section, using lower extremity pneumatic compression devices, medications, or both
  • 24/7 access to standard electronic antepartum records for most patients
  • Internet-based required reading and testing for all attendings and residents
  • Early identification of adverse outcomes and potential liability cases and proactive outreach to the patient when a clear medical error was identified, with a goal of an early settlement.

Blueprint Area(s) Addressed

Strategies Used

Filed in Blueprint, Clinical audit, case review, or analysis of adverse events, Clinical practice guideline/policy change, Educational materials for health professionals, Health information technology, Health information technology, Health professions education, Improved liability system, In the Literature, Progress, Risk management/liability reform, Skills training or drills for health professionals, Staffing/care coordination change, Team building, Workforce on Sun., Mar 6, 2011