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      We thank the authors of the letter for their interest in our article. It is the melding of ideas from many sources that can improve patient safety.
      What were the criteria used to classify an incident as a “sentinel event” in the study?
      We used the same definition of a sentinel event as The Joint Commission. It is a misread of our paper to interpret otherwise.
      How might a broader definition of “sentinel event” to include nonfatal adverse outcomes and near misses have changed the study results and implications?
      Nonfatal serious adverse outcomes are included in the definition of a “sentinel event,” as defined by the Joint Commission. It was not our purpose to assess all adverse obstetric and neonatal outcomes. These types of data are not as accurate in a retrospective study and we chose not to make such an attempt.
      The program's impact might be more widely celebrated if results showed a decrease in often preventable adverse obstetric outcomes such as unnecessary major surgical procedures (Weill Cornell has a extraordinarily high cesarean section rate).
      We strongly disagree with the author's characterization that cesarean deliveries are “preventable adverse obstetric outcomes” or are “unnecessary surgical procedures.” The timely performance of an indicated cesarean delivery enhances the safety of both the pregnant woman and the fetal patient. The characterization of the cesarean rate at Weill Cornell as “extraordinarily high” is inaccurate. Raw cesarean rates are not comparable. We have recently demonstrated that Weill Cornell's cesarean rate is below that of the national average when adjusted for risks such as maternal age and parity.
      • Grünebaum A.
      • Chervenak F.
      • Skupski D.
      Population-based standardization (PBS) of institutional cesarean delivery rates.
      How did the criteria for identifying sentinel events change at the hospital over the study period?
      The criteria for identifying sentinel events did not change over the study period.
      What organizational system-level changes have occurred to prevent the recurrence of adverse outcomes?
      Our paper reported on the positive effect of organizational changes on sentinel events and liability expenses. We agree that root cause analysis is an invaluable tool and should be part of any sentinel event process. This tool was used with decreasing frequency because of the increasing success of our patient safety efforts.
      Are there data on the number of and costs to defend nonlawsuit, noncatastrophic claims and the frequency of error reporting and disclosure?
      These data are not available.

      Reference

        • Grünebaum A.
        • Chervenak F.
        • Skupski D.
        Population-based standardization (PBS) of institutional cesarean delivery rates.
        J Perinat Med. 2008; 36: 110-114

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