title: Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety.
abstract: 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.
authors.affiliation: Hospital Corporation of America, Nashville, TN, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Clark
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.forename: Spencer L
authors.initials: SL
authors.lastname: Byrum
authors.forename: Janet A
authors.initials: JA
authors.lastname: Meyers
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Perlin
mesh_terms: 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
chemical_list: D010120:Oxytocics; D016595:Misoprostol