As part of a larger program to achieve zero preventable birth injuries, this project’s goal was to avoid tachysystole or appropriately intervene when tachysystole occurred. Tachysystole is defined as more than 5 contractions in 10 minutes, averaged over a 30-minute window, and is often associated with induced or augmented labor.
Improved liability system
The Safe Motherhood Quilt Project, originated by midwife Ina May Gaskin, is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States. The Quilt honors American mothers who have died of pregnancy or childbirth related causes since 1982, the last year there was a reduction in maternal mortality.
The goal of the Safe Motherhood Quilt Project is to demand an equivalent system of counting, analyzing, and learning from mistakes made in our maternity care system here, regardless of where babies are born or what caregiver is the birth attendant. Until we do that, doctors, midwives, and nurses in the US will continue to work without a good system of feedback about what is and is not dangerous in maternity care, and preventable maternal deaths will continue to take place.
For all scheduled cesarean deliveries, the hospital introduced a preoperative checklist to verify patient identity, indication for caesarean section, allergies, and presence of neonatology staff and a postoperative check to verify analgesia, oxytocic prescription, antibiotics, thromboprophylaxis and skin contact between mother and baby. Researchers examined staff attitudes before and after introduction of the checklists, checklist compliance, and whether patients experienced anxiety or were reassured by the process.
From the Field: Eliminating Preventable Perinatal Injuries and Reducing Malpractice Claims and Costs: Creating High Reliability Obstetrics Units
We intend to reduce perinatal harm and decrease malpractice events by eliciting improved compliance in 4 clinical care bundles and implementation of an evidence-based simulation training methodology focused on improving clinical staff’s ability to work in teams. We are measuring our impact through a culture of safety survey and a high reliability survey, various outcomes measures.
In the Literature: A comprehensive perinatal patient safety program to reduce preventable adverse outcomes and costs of liability claims
After implementation of this comprehensive patient safety program, birth trauma rates decreased, the number of obstetrical occurrences (specified birth-related event or injury that may lead to a claim) decreased by 65%, and the average costs per obstetrical claim decreased. The number of new claims reported decreased by 48%.
In the Literature: HCA reduces liability claims, cesarean sections with comprehensive patient safety approach
The general approach described in this article is the standardization of practices and protocols for several clinical situations associated with high risk of injury or harm, specifically use of oxytocin, misoprostol, or magnesium sulfate; operative vaginal delivery; and the management of shoulder dystocia and abnormal fetal heart rate tracings. In the period since the implementation of the comprehensive patient safety program, HCA saw a dramatic decrease in malpractice claims and loss rates. In addition, the primary cesarean section rate fell despite a generally liberal approach to operative delivery.
In the Literature: Comprehensive patient safety program results in dramatic decrease in adverse events, 99% reduction in malpractice payments
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.