Improved patient safety process yields fewer cesareans, less litigation

Patient outcomes improved, litigation declined dramatically, and fewer babies were born by cesarean delivery after a comprehensive redesign of the patient safety process at a major hospital group, researchers report in the August issue of the American Journal of Obstetrics and Gynecology.

Steven L. Clark, MD, and colleagues at the Hospital Corporation of America in Nashville, Tenn., which has 120 facilities in 21 states providing approximately 220,000 deliveries a year, write that the revised safety process was based on five principles.

There was an assumption that quality could be improved through uniform processes and procedures. Any member of the obstetric team was required to halt any process deemed to be dangerous, and cesarean delivery was viewed not as a quality end point or outcome but as a process alternative. Unambiguous practice guidelines and reducing adverse outcomes were seen as key to reducing malpractice loss and, finally, effective peer review was recognized as essential to quality medical practice, but not always feasible at a local level in some departments, the report indicates. The redesigned process resulted in significant improvements in patient safety, litigation and cesarean delivery rates.

“These results are encouraging and suggest that our use of a different patient safety paradigm, based on the aforementioned principles, may be of value in addressing some of the most vexing problems in obstetrics and, more generally, in creating highly reliable health care,” the authors write.

Clark

SL,

Belfort

M,

Byrum

SL, et al. Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety.

Am J Obstet Gynecol.

2008;199:105.e1-105.e7