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.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Neonatal and Perinatal Mortality, 2006.
- Variations in the rate of Operative Delivery in the United States.Am J Obstet Gynecol. 2007; 196: 526-527
- Comparison of a trial of labor with an elective second cesarean section.N Eng J Med. 1996; 335: 689-695
- Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery.N Eng J Med. 2004; 351: 2581-2589
- Elective prophylactic cesarean delivery.ACOG Clin Rev. 2005; 10: 1-15
- Term neonatal asphyxial seizures and peripartum deaths: Lack of correlation with a rising cesarean delivery rate.Am J Obstet Gynecol. 2005; 192: 102-108
- Rising cesarean section rates: a cause for concern?.BJOG. 2003; 110: 346-349
- Can a 29% cesarean delivery rate possibly be justified?.Obstet Gynecol. 2006; 107: 752-754
- Temporal and demographic trends in cerebral palsy—fact and fiction.Am J Obstet Gynecol. 2003; 188: 628-633
Frye V. United States 26.293 F. 1013 (DC Cir 1923).
Daubert V. Merrel Dow Pharmaceuticals, 509 US 579 (1993).
- Unwarranted variations in healthcare delivery: Implications for academic medical centers.BMJ. 2002; 325: 961-965
- Variation—the root of all process evil.
- Implementation of a conservative checklist-based protocol for oxytocin administration: Maternal and newborn outcomes.Am J Obstet Gynecol. 2007; 197 (480e1–5)
Gould SJ. Full house: The spread of excellence from Plato to Darwin. New York (NY): Three Rivers Press. p. 112–32.
- Highly reliability theory and reliable organizations.AORN J. 2005; 81: 1319-1322
- Reliable organizations: Present research and future directions.J Contingency Crisis Management. 1996; 4: 55-59
- Press release SB-05-09.National Transportation Safety Board, Washington (DC)2005 (March 29)
- Cockpit checklists: Concepts, design and use.Hum Factors. 1993; 35: 28-43
- The Toyota way: 14 management principles from the world's greatest manufacturer.McGraw-Hill, New York (NY)2004
- Vaginal delivery after a previous cesarean birth.American College of Obstetrician and Gynecologist Committee Opinion #143, 1994 (October)
- Uterine rupture after previous cesarean delivery: Maternal and fetal consequences.Am J Obstet Gynecol. 1993; 169: 945-950
- Reducing obstetric litigation through alterations in practice patterns—experience with 189 closed claims.Am J Obstet Gynecol. 2006; 195: S118
- Who is at greatest risk for receiving poor quality health care?.N Engl J Med. 2006; 354: 1147-1156
Article Info
Publication History
Published online: May 12, 2008
Accepted:
February 14,
2008
Received in revised form:
November 26,
2007
Received:
October 16,
2007
Footnotes
Reprints not available from the authors.
Cite this article as: Clark SL, Belfort MA, Byrum SL, et al. Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety. Am J Obstet Gynecol 2008;199:105.e1-105.e7.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
