title: Comprehensive perinatal safety initiative to reduce adverse obstetric events.
abstract: A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.
authors: North Shore-Long Island Jewish Health System, Great Neck, NY, USA.
authors: Brian
authors: B
authors: Wagner
authors: Natalie
authors: N
authors: Meirowitz
authors: Jalpa
authors: J
authors: Shah
authors: Deepak
authors: D
authors: Nanda
authors: Lori
authors: L
authors: Reggio
authors: Phyllis
authors: P
authors: Cohen
authors: Karen
authors: K
authors: Britt
authors: Leah
authors: L
authors: Kaufman
authors: Rajni
authors: R
authors: Walia
authors: Corinne
authors: C
authors: Bacote
authors: Martin L
authors: ML
authors: Lesser
authors: Renee
authors: R
authors: Pekmezaris
authors: Adiel
authors: A
authors: Fleischer
authors: Kenneth J
authors: KJ
authors: Abrams
mesh_terms: D055317:Evidence-Based Practice / Q000193:education / Q000592:standards; D005260:Female; D005323:Fetal Monitoring / Q000379:methods / Q000592:standards; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D019982:Organizational Case Studies; D061214:Patient Safety; D017060:Patient Satisfaction; D018743:Perinatal Care / Q000379:methods / Q000592:standards*; D010564:Personnel, Hospital / Q000193:education*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D017751:Safety Management / Q000379:methods / Q000458:organization & administration / Q000592:standards*