title: Impact of a comprehensive patient safety strategy on obstetric adverse events.
abstract: OBJECTIVE
  We implemented a comprehensive strategy to track and reduce adverse events.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  A systematic strategy to decrease obstetric adverse events can have a significant impact on patient safety.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Yale University School of Medicine, New Haven, CT 06520-8063, USA. christian.pettker@yale.edu
authors.forename: Christian M
authors.initials: CM
authors.lastname: Pettker
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Thung
authors.forename: Errol R
authors.initials: ER
authors.lastname: Norwitz
authors.forename: Catalin S
authors.initials: CS
authors.lastname: Buhimschi
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Raab
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Copel
authors.forename: Edward
authors.initials: E
authors.lastname: Kuczynski
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lockwood
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D009773:Obstetric Nursing / Q000458:organization & administration; D009774:Obstetrics / Q000458:organization & administration / Q000592:standards; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration* / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration; D011247:Pregnancy; D011367:Professional Staff Committees / Q000458:organization & administration; D015397:Program Evaluation; D012308:Risk Management / Q000458:organization & administration*; D017751:Safety Management / Q000458:organization & administration*; D013192:Staff Development / Q000458:organization & administration; D011795:Surveys and Questionnaires