Increasing Obstetric Patient Safety and Decreasing Compensation Payments

March 31, 2011

Answering the Institute of Medicine’s call to improve patient safety, the New York Presbyterian Hospital-Weill Cornell Medical Center undertook a step-wise, comprehensive, and ongoing safety program. The program was conceived in 2002 and began with a review by independent consultants.

Answering the Institute of Medicine’s call to improve patient safety, the New York Presbyterian Hospital-Weill Cornell Medical Center undertook a step-wise, comprehensive, and ongoing safety program. The program was conceived in 2002 and began with a review by independent consultants.  

To determine the efficacy of the initiatives, Dr Amos Grunebaum, associate professor of obstetrics and gynecology at the New York Hospital-Cornell Weill Medical College, and colleagues conducted a retrospective review of obstetric compensation payments and sentinel events, including maternal deaths, and serious newborn injuries, such as birth asphyxia and hypoxic ischemic encephalopathy.

The hospital-a tertiary academic referral center with a level-3 neonatal intensive care unit and a New York State regional perinatal center-has approximately 5200 deliveries annually; voluntary attending physicians manage about one-quarter of the births while the rest are managed by full-time faculty. Following the 2002 independent review, the hospital instituted a series of policies and training opportunities to strengthen safety and enhance communications among health care personnel in the labor and delivery department (Figure).

Figure. Timing of steps, programs and policies implemented.

2002Independent review
2003Labor and delivery team training; Electronic medical record charting; Chain of communication for labor and delivery training
2004Dedicated gynecology attending on call; Limitation of misoprostol to induction of labor or cervical ripening for a nonviable fetus
2005Standardized oxytocin labor induction and stimulation protocol; Premixed and safety color-coded labeled magnesium sulfate and oxytocin solutions; Electronic medical record templates for shoulder dystocia and operative deliveries; Early identification of potential obstetric professional liability cases; Obstetric patient safety nurse
2006Electronic online communication whiteboard; Recruitment of physician’s assistants for labor and delivery; Electronic fetal monitor interpretation certification; Electronic antepartum medical records; Routine thromboembolism prophylaxis for all cesarean deliveries; Obstetric emergency drills
2007Recruitment of a laborist
2009Oxytocin initiation checklist; Postpartum hemorrhage kit; Internet-based required reading assignments and testing

 

Grunebaum and associates analyzed data from 2003 to 2009 from the hospital’s sentinel event adverse outcome database, which is recorded by the hospital’s quality assurance committee. They also looked at new and ongoing significant liability suits, including related compensation payments.

They found that the average compensation total payments between 2003 and 2006 dropped from more than $27.5 million to $250,000. In addition, the number of sentinel events also saw dramatic declines, from 1.04 sentinel events per 1000 deliveries in 2000 to zero sentinel events in 2008 and 2009. Furthermore, the hospital had no maternal deaths on the labor and delivery ward for the past 6 years, and no permanent Erb palsy has been reported since shoulder dystocia drills began in 2008.

“Our results show that implementing a comprehensive obstetric patient safety program not only decreases severe adverse outcomes but can also have an immediate impact on compensation payments,” concluded Grunebaum and colleagues. “The $25,041,475 yearly savings in compensation payments for the last 3 years alone dwarf the incremental cost of the patient safety program.”

More Information

New York-Presbyterian/Weill Cornell Medical Center 

Reference

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.