Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety.
In a health care delivery system with an annual delivery rate of approximately 220,000, a comprehensive redesign of patient safety process was undertaken based on the following principles: (1) uniform processes and procedure result in an improved quality; (2) every member of the obstetric team should be required to halt any process that is deemed to be dangerous; (3) cesarean delivery is best viewed as a process alternative, not an outcome or quality endpoint; (4) malpractice loss is best avoided by reduction in adverse outcomes and the development of unambiguous practice guidelines; and (5) effective peer review is essential to quality medical practice yet may be impossible to achieve at a local level in some departments. Since the inception of this program, we have seen improvements in patient outcomes, a dramatic decline in litigation claims, and a reduction in the primary cesarean delivery rate.
Clark
Steven L
SL
Hospital Corporation of America, Nashville, TN, USA.
Belfort
Michael A
MA
Byrum
Spencer L
SL
Meyers
Janet A
JA
Perlin
Jonathan B
JB
D002585:Cesarean Section / Q000706:statistics & numerical data*; D002985:Clinical Protocols / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008318:Malpractice / Q000706:statistics & numerical data*; D016595:Misoprostol / Q000008:administration & dosage; D007744:Obstetric Labor Complications / Q000517:prevention & control; D009774:Obstetrics / Q000379:methods / Q000458:organization & administration / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010120:Oxytocics / Q000008:administration & dosage; D010380:Peer Review; D011247:Pregnancy; D011256:Pregnancy Outcome; D011787:Quality of Health Care; D014481:United States
D010120:Oxytocics; D016595:Misoprostol