title: A comprehensive obstetric patient safety program reduces liability claims and payments.
abstract: Begun in 2003, the Yale-New Haven Hospital comprehensive obstetric safety program consisted of measures to standardize care, improve teamwork and communication, and optimize oversight and quality review. Prior publications have demonstrated improvements in adverse outcomes and safety culture associated with this program. In this analysis, we aimed to assess the impact of this program on liability claims and payments at a single institution. We reviewed liability claims at a single, tertiary-care, teaching hospital for two 5-year periods (1998-2002 and 2003-2007), before and after implementing the safety program. Connecticut statute of limitations for professional malpractice is 36 months from injury. Claims/events were classified by event-year and payments were adjusted for inflation. We analyzed data for trends as well as differences between periods before and after implementation. Forty-four claims were filed during the 10-year study period. Annual cases per 1000 deliveries decreased significantly over the study period (P < .01). Claims (30 vs 14) and payments ($50.7 million vs $2.9 million) decreased in the 5-years after program inception. Compared with before program inception, median annual claims dropped from 1.31 to 0.64 (P = .02), and median annual payments per 1000 deliveries decreased from $1,141,638 to $63,470 (P < .01). Even estimating the monetary awards for the 2 remaining open cases using the median payments for the surrounding 5 years, a reduction in the median monetary amount per case resulting in payment to the claimant was also statistically significant ($632,262 vs $216,815, P = .046). In contrast, the Connecticut insurance market experienced a stable number of claims and markedly increased cost per claim during the same period. We conclude that an obstetric safety initiative can improve liability claims exposure and reduce liability payments.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Pettker
authors.affiliation: Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Thung
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Lipkind
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Illuzzi
authors.affiliation: Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Catalin S
authors.initials: CS
authors.lastname: Buhimschi
authors.affiliation: Yale-New Haven Hospital, New Haven, CT.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Raab
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Copel
authors.affiliation: Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lockwood
authors.affiliation: Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Edmund F
authors.initials: EF
authors.lastname: Funai
mesh_terms: D001720:Birth Injuries / Q000191:economics / Q000209:etiology; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D003237:Connecticut; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000191:economics / Q000331:legislation & jurisprudence; D005260:Female; D006784:Hospitals, Teaching / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards* / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D016365:Liability, Legal / Q000191:economics*; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data / Q000639:trends; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards* / Q000639:trends; D061214:Patient Safety / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards*; D011247:Pregnancy; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics
keywords: medical liability; medical malpractice; obstetric adverse outcomes; patient safety