Impact of a comprehensive patient safety strategy on obstetric adverse events

Christian M Pettker, Stephen F Thung, Errol R Norwitz, Catalin S Buhimschi, Cheryl A Raab, Joshua A Copel, Edward Kuczynski, Charles J Lockwood, Edmund F Funai
American Journal of Obstetrics and Gynecology 2009, 200 (5): 492.e1-8

OBJECTIVE: We implemented a comprehensive strategy to track and reduce adverse events.

STUDY DESIGN: We incrementally introduced multiple patient safety interventions from September 2004 through November 2006 at a university-based obstetrics service. This initiative included outside expert review, protocol standardization, the creation of a patient safety nurse position and patient safety committee, and training in team skills and fetal heart monitoring interpretation. We prospectively tracked 10 obstetrics-specific outcome. The Adverse Outcome Index, an expression of the number of deliveries with at least 1 of the 10 adverse outcomes per total deliveries, was analyzed for trend.

RESULTS: Our interventions significantly reduced the Adverse Outcome Index (linear regression, r(2) = 0.50; P = .01) (overall mean, 2.50%). Concurrent with these improvements, we saw clinically significant improvements in safety climate as measured by validated safety attitude surveys.

CONCLUSION: A systematic strategy to decrease obstetric adverse events can have a significant impact on patient safety.

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