Patient safety in obstetrics — the Hospital Corporation of America Experience
We report an update on obstetric patient safety efforts and results in the nation's largest obstetric health care delivery system. The application of principles advocated by the Institute of Medicine a decade ago has resulted in reduced adverse outcomes, as reflected by claims experience. Particular progress has been made in standardization and documentation of critical processes, establishment of national quality benchmarks, reduction in elective deliveries <39 weeks' gestation, and reduction in fatal postcesarean pulmonary embolism. Our experience provides a useful blueprint for similar progress in other health care systems.
Available from: Jan Norum
- "They concluded the instrument valid and feasible to assess patient safety and may be used for quantitative analysis of patient records and to identify unsafe situations. The Hospital Corporation of America recently presented their obstetric patient safety efforts and results . Standardization and documentation of critical processes, establishment of national quality benchmarks, reduction in elective deliveries before 39 weeks gestation and reduction in fatal post-caesarean pulmonary embolism were the major areas of progress. "
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ABSTRACT: It is challenging to obtain high quality obstetric care in a sparsely populated area. In the subarctic region of Norway, significant distances, weather conditions and seasonable darkness have called for a decentralized care model. We aimed to explore the quality of this care.
A retrospective study employing data (2009--11) from the Medical Birth Registry of Norway was initiated. Northern Norwegian and Norwegian figures were compared. Midwife administered maternity units, departments at local and regional specialist hospitals were compared. National registry data on post-caesarean wound infection (2009--2010) was added. Quality of care was measured as rate of multiple pregnancies, caesarean section, post-caesarean wound infection, Apgar score <7, birth weight <2.5 kilos, perineal rupture, stillbirth, eclampsia, pregnancy induced diabetes and vacuum or forceps assisted delivery. There were 15,586 births in 15 delivery units.
Multiple pregnancies were less common in northern Norway (1.3 vs. 1.7%) (P = 0.02). Less use of vacuum (6.6% vs. 8.3%) (P = 0.01) and forceps (0.9% vs 1.7%)(P < 0.01) assisted delivery was observed. There was no difference with regard to pregnancy induced diabetes, caesarean section, stillbirth, Apgar score < 7 and eclampsia. A significant difference in birth weight < 2.5 kilos (4.7% vs. 5.0%) (P < 0.04) and perineal rupture grade 3 and 4 (1.5% vs. 2.3%) (P < 0.02) were revealed. The post-caesarean wound infection rate was higher (10.5% vs. 7.4%) (P < 0.01).
Northern Norway had an obstetric care of good quality. Birth weight, multiple pregnancies and post-caesarean wound infection rates should be further elucidated.
Available from: Y. Tony Yang
- "Harnessing potential of electronic health records to foster access to full and accurate documentation and data collection and to support appropriate care Bernstein, Farinelli, & Merkatz, 2005; Cusack, 2008; Eden et al., 2008; George & Bernstein, 2009; Haberman et al., 2009; Nielsen, Thomson, Jackson, Kosman, & Kiley, 2000; Quinn, Kats, Kleinman, Bates, & Simon, 2010 Building effective teams, improving interpersonal relationships and communication and strengthening collaborative practice Hickson & Entman, 2008; Lyndon et al., 2012; Lyndon, Zlatnik, & Wachter, 2011; Mann & Pratt, 2008; Meri en et al., 2010; Nielsen & Mann, 2008; Pratt et al., 2007; Williams et al., 2010 Implementing high-reliability practice that aligns care with best evidence and reduces practice variation, including use of clinical decision support, protocols, explicit evidence-based guidelines, checklists, etc. Clark et al., 2011; Clark, Belfort, Byrom et al., 2008; Clark, Belfort, Saade et al., 2007; Fausett, Propst, Van Doren, & Clark, 2011; Grobman et al., 2011; Hasley, 2011; Knox & Simpson, 2011; Pettker, 2011 Implementing quality of care peer review systems ( "
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ABSTRACT: The present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise.
We considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable.
Ten strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy-implementing rigorous maternity care quality improvement (QI) programs-has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels.
A number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win-win-win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.
Available from: mintsmedmal.com
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ABSTRACT: While unsafe behavior of frontline hospital staff, primarily physicians and nurses, is sometimes the proximal cause of adverse events, the critical importance of system-wide, hospital organizational factors is now being acknowledged(1,2). These organizational factors create the "safety culture" that influences the occurrence of these proximal failures.(3) The concept of safety culture originated in high-reliability organization theory, which was largely developed by a group of social scientists at the University of California at Berkeley who studied high-risk organizations that have achieved very low accident and error rates, for example, aircraft carrier flight decks, nuclear power plants and air-traffic control systems.(4-6) Safety culture refers to the enduring and shared beliefs and practices of organization members regarding the organization's willingness to detect and learn from errors.(7).
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