Abstract
BackgroundThis study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety.MethodsWe included 71 critical incidents in primary midwifery care and subsequent hospital care in case of referral after 36 weeks of pregnancy that were related to substandard care and for that reason were reported to the Health Care Inspectorate in The Netherlands in 36 months (n = 357). We performed a case-by-case analysis, using a previously validated instrument which covered five broad domains: healthcare organization, communication between healthcare providers, patient risk factors, clinical management, and clinical outcomes.ResultsDeterminants that were associated with risk concerned healthcare organization (n = 20 incidents), communication about treatment procedures (n = 39), referral processes (n = 19), risk assessment by telephone triage (n = 10), and clinical management in an out of hours setting (n = 19). The 71 critical incidents included three cases of maternal death, eight cases of severe maternal morbidity, 42 perinatal deaths and 12 critical incidents with severe morbidity for the child. Suboptimal prenatal risk assessment, a delay in availability of health care providers in urgent situations, miscommunication about treatment between care providers, and miscommunication with patients in situations with a language barrier were associated with safety risks.ConclusionsSystematic analysis of critical incidents improves insight in determinants of safety risk. The wide variety of determinants of risk of critical incidents implies that there is no single intervention to improve patient safety in the care for pregnant women with initially a low risk profile.
Highlights
This study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety
Netherlands have a low risk pregnancy profile in early pregnancy and receive primary midwifery care, about 30% of these a priori low risk pregnant women are being referred to a hospital mainly during the third trimester of their pregnancy, and 20% of these women are referred while giving birth [3]
We focused our analysis on primary midwifery care for low risk pregnant women and hospital care for these women in case of referral after 36 weeks of pregnancy
Summary
This study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety. The remaining 30% of the low risk pregnant women remain in primary midwifery care and give birth, either at home (18%) or in a hospital (12%). A large national study found no relation between births led by primary care midwives and increased risk of perinatal death in The Netherlands [7]. A study on maternal outcomes among low risk women with planned home versus hospital births in The Netherlands showed that low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity than those with planned hospital birth [8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
