Patient safety in obstetrics

Obstetrical care providers are highly trained, highly skilled professionals working with complex systems in an unpredictable environment. Perinatal units have many built-in mechanisms that work to prevent errors from occurring. Unintentional failures usually are the result of a chain of events, almost never from a single cause or a single provider. Within most unintentional failures, there is usually no single explanatory cause for the event. Rather, there is a complex interaction between a varied set of systems, including human behavior, performance and interdependency, technological aspects, socio-cultural factors, and a range of organizational and procedural weaknesses. To enable meaningful analysis of the underlying causes of an adverse event, errors and near-misses must be made visible. The challenge lies in the integration of labor and delivery clinical core business with high-reliability organization principles. The human factors knowledge should be considered a required part of the undergraduate and postgraduate medical education. Safety science and human factors engineering need to be applied to perinatal care, and each health care professional should be able to recognize the basic theories, rules, and principles. Business and industry provide many lessons for perinatal care when focusing on error prevention through standardization, information technology, and, last but not least, acknowledging the relationship between team-building and improved performance. This will allow all obstetrical caregivers to build and maintain confidence and competency in their daily clinical activities, which ultimately is believed to result in reduction of clinical error. This review on current patient safety issues as they are applicable to the field of perinatal care attempts to create a sense of urgency towards the creation of a safety-conscious culture in obstetrics. Such a culture fosters a collective approach of responsibility to learn and improve constantly. This process takes time to develop and requires dedicated and highly visible leadership support at every level.     

ACOG committee opinion number 286, October 2003: patient safety in obstetrics and gynecology

Emphasis on patient safety has increased in the past few years mostly in response to the Institute of Medicine report "To Err Is Human: Building a Safer Health System." Obstetrician*gynecologists should incorporate elements of patient safety into their practices and also encourage others to use these practices. The American College of Obstetricians and Gynecologists (ACOG) is committed to improving quality and safety in women's health care. The Institute of Medicine report, "To Err Is Human: Building a Safer Health System," notes that errors in health care are a significant cause of death and injury. Despite disagreements over the actual numbers cited, all health care professionals agree that patient safety is extremely important and should be addressed by the overall health care system. The American College of Obstetricians and Gynecologists continues to emphasize its long-standing commitment to quality and patient safety by codifying a set of objectives that should be adopted by obstetrician*gynecologists in their practices. Obstetrician*gynecologists are encouraged to promulgate these principles in the hospitals and other settings where they practice.     

Elements of a successful quality improvement and patient safety program in obstetrics and gynecology

In this article we present the elements of one approach to quality improvement and patient safety that we believe can be successful and sustainable in the field of obstetrics and gynecology, along with several strategies (and caveats) that have worked and are working in academic and nonacademic institutions in the United States. Also included are several noteworthy definitions of quality to provide some additional perspectives on what is meant by quality in health care.     

Ultrasound in obstetrics: a review of safety.

The data available to data suggest that diagnostic US has no adverse effect on embryogenesis or fetal growth. However, although B and M mode are safe during the first trimester, color, pulsed or power Doppler should be performed with caution. The US effects are mainly due to cavitation. However, this Mechanism has been determined mainly in animal models. Thermal effect, which was thought to be hazardous, probably does not influence fetal development.     

Working toward a common goal: a collaborative obstetrics and gynecology practice

Health care reform in the United States will continue to necessitate creativity in the organization and staffing of health care models. The Department of Obstetrics and Gynecology at Bronx-Lebanon Hospital Center has expanded its staff by placing midwives as primary providers for most routine care and much of the specialty care offered within the department. Midwives and attending physicians work collaboratively in outpatient specialty clinics. Inpatient care is provided by a team of midwives, residents, and attending physicians. This model of care is easily replicated, and has resulted in improvements in clinical practice and increased patient and personnel satisfaction.     

Proceedings of the XVII and XVIII European meeting of trainees in obstetrics and gynaecology: moving towards European training in obstetrics and gynaecology

Trainees in obstetrics and gynaecology have officially organised meetings for European trainees since 1992. In order to understand each other better and appreciate differences in training, an annual exchange program and a meeting were developed to discuss topics related to training and harmonisation. The proceedings from the 17th meeting in Austria and the 18th meeting in Portugal serve as an illustration of the current status in Europe regarding ‘assessment’ and ‘working conditions’ during specialist training for obstetrics and gynaecology. ENTOG aims to represent all European trainee organisations in obstetrics and gynaecology and speak out on their behalf.     

Patient safety in obstetrics and gynecology: an agenda for the future

The effect of medical errors and unsafe systems of care has had a profound effect on the practice of obstetrics and gynecology. From 1975 to 2000, medical malpractice costs for obstetrician-gynecologists have risen nearly four-fold higher than that of other medical costs. In addition, it has been estimated that defensive medicine may cost society $80 billion per year. Most importantly, many obstetrician-gynecologists are frustrated and seem to be abandoning the parts of their practice they perceive to put them at higher liability risk. This article discusses other medical specialty society efforts that have been successful in addressing the area of patient safety. Efforts to better track quality outcomes has been initiated by the American College of Surgeons through the National Surgical Quality Improvement Project, and the American Society of Anesthesiologists has demonstrated both dramatically improved outcomes and reduced liability costs through a concerted patient safety effort. The author proposes changes in four areas to specifically address patient safety in obstetrics and gynecology, including: the development of reliable and reproducible quality control measures (and a system to track them); national closed claim reviews to better understand and address the most important safety and liability areas for obstetrician-gynecologists; work prospectively with pharmaceutical and surgical device manufacturers to develop innovative new products that would increase the likelihood of safe outcomes; and create a culture of safety in obstetrics and gynecology by incorporating safety education into all levels of training.     

Efficiency and safety of magnesium sulfate treatment in obstetrics

Current views on efficacy and safety of magnesium sulfate treatment in obstetrics are presented. Negative effects of MgSO4 on fetus and newborn are described. Contradictory reports dealing with tocolytic efficacy of magnesium sulfate are discussed.     

Obstetric patient safety: an overview

Patient safety, defined as "the absence of the potential for, or the occurrence of, health care associated injury to the patient," is a part of the larger concept of health care quality. Achieving safe patient care has become an increasing focus of the obstetric community, in part due to the realization of the number of preventable adverse events that occur as well as the pressures of the professional liability climate. Studies of obstetric care have revealed that multiple factors contribute to the occurrence of adverse obstetric events, although communication is one factor that consistently has been found to prominently contribute to these events. The data that exist also suggest that although most women who give birth on a labor and delivery unit do so without a significant safety incident, a notable minority does experience an event that may compromise their ability to achieve an optimal outcome.     

Using technology to promote perinatal patient safety

Leaders in health care and national health policy recommend information technology information technology as a strategy to promote patient safety. Technology enables error prevention, surveillance, and analysis. Although there is little research about technology and safety in perinatal care, nurses in the specialty can use current evidence about the electronic health record, decision support systems, and medication safety devices to guide practice. This article includes key issues and general recommendations for the use of information technology to promote patient safety, the most common applications relevant to perinatal care, and strategies for perinatal nurses who implement information technology to promote patient safety.     

Measuring patient safety in neonatology

Measurement of patient safety serves to identify opportunities to improve safety within a neonatal intensive care unit (NICU), compare the safety of care provided by different NICUs, determine changes in response to safety interventions or programs, follow safety trends over time, and potentially deny payment for specific events. The ideal patient safety measures are rates of events derived from surveillance with valid and reliable detection of numerators (errors or adverse events) and denominators (the opportunities for errors or adverse events to occur). Methods used to identify these numerators and denominators include reporting, direct observation, videotaping, chart review, trigger tools, and automated methods. However, there are significant methodological and practical (feasibility) challenges to the accurate and reliable determination of rates of errors and adverse events. These include failure to detect and document such events, surveillance bias, lack of consistent definitions, frequent requirement for judgment in identifying and classifying challenges (which introduces interrater inconsistency), and need for significant additional resources.