Additionally, it is important to establish methods of communication early on, and to deliver and communicate tangible successes as soon as possible.
The OB Right program communicates with the health care team through posters on labor and delivery, and a newsletter that reports every 3 months on the issues and successes of the program. It also has a Web site with educational modules, near-miss reporting, meeting schedules and minutes, and other interactive tools.
Since OB Right began, we've almost eliminated elective deliveries at less than 39 weeks' gestation, and have achieved an almost-universal compliance with simultaneous maternal and fetal heart rate tracing and measurement of arterial and venous cord pH at both hospitals.
One of the major liability insurance companies sends a representative to the OB Right steering committee meetings and provides premium discounts for physician participation in the OB Right program.
As reported in the Institute of Medicine report “Crossing the Quality Chasm: A New Health System for the 21st Century,” the biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures but as opportunities to improve the system and prevent harm.
ELSEVIER GLOBAL MEDICAL NEWS
Quality of Care in Obstetrics
Patient safety has become an emphasized area of medicine in recent years. This is not to suggest that the issue of patient safety is new to medicine. Historically, it has been assumed to be a natural part of good medicine and the provision of good medical care.
In 1999, the Institute of Medicine released shocking statistics, estimating that as many as 98,000 people die in any given year as a result of medical errors that occur in hospitals. In the now well-cited report “To Err Is Human: Building a Safer Health Care System,” the IOM asserted that errors occur because good physicians and health care providers work within a bad system. It set a minimum goal of reducing errors by 50% over the next 5 years, and laid out a national agenda for improving patient safety.
This report was followed up by another IOM report published in 2001, “Crossing the Quality Chasm: A New Health Care System for the 21st Century.” This report further defined what kind of change is needed to “close the quality gap.” It provided overarching principles for clinicians, among others, and looked at how systems approaches can be used to implement change.
With both reports—two of many IOM studies and publications aimed at improving the nation's quality of care—a light has been shown nationally and internationally on the importance of not simply assuming that good quality care is part of medicine but, instead, emphasizing and critically analyzing the state of affairs relative to patient safety and quality of care.
Most of our institutions by now have implemented major organizational and structural changes aimed specifically at introducing safety and quality measures. These changes and structures—and the ensuing outcomes—must be monitored so that deviations from the currently available national best practices and standards of care can be identified and corrected.
In obstetrics in particular, where the litigious environment is so challenging, patient safety initiatives become even more important. For this reason, we believe that a Master Class highlighting a particular safety and quality of care initiative in obstetrics may both provide guidance and serve as a catalyst for other centers to emulate.
We have invited Dr. Alfred Z. Abuhamad to be our guest professor. Dr. Abuhamad serves as chairman of the department of ob.gyn. at the Eastern Virginia Medical School, Norfolk, and is the Mason C. Andrews Professor of Obstetrics and Gynecology there. He has played a key role in establishing a patient safety initiative in labor and delivery at EVMS and Sentara Healthcare, and will share, in detail, what he and his colleagues have learned in implementing this initiative.
Key Points About Patient Safety
▸ An estimated 44,000–98,000 patients die each year from errors made during hospital stays.
▸ Two-thirds of perinatal sentinel events are primarily linked to communication issues.
▸ Experience with the OB Right patient safety initiative at Eastern Virginia Medical School and Sentara Healthcare has demonstrated the importance of common language and common understanding when it comes to fetal heart rate monitoring.
▸ To significantly diminish unnecessary prematurity and its associated morbidity, patient safety initiatives should include elective induction and C-section bundles that require either a gestational age of at least 39 weeks or documented fetal lung maturity.