Risk Management In Obstetrics Research Articles

Risk management in obstetrics

Risk management is a vital tool in preventing repetition of errors which are costly to patients, staff and institutions. If risk management is used appropriately, faults in the system can be eliminated before they cause an event, or to prevent event recurrence. With detailed analysis of incidents (using tools such as root cause analysis) the fault in the system (rather that the individual) can be identified and rectified. The evolution of risk management (and its development from industry to the health sector) in the UK is described. The cost to the health service is explored and methods of analysing risk are discussed (including risk registers). There is a description of the elements that are reviewed in a Clinical Negligence Scheme for Trusts assessment. There is also a worked example of a clinical incident, its analysis and the solutions recommended.

Obstetric Simulation as a Risk Control Strategy

Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.

Risk management in obstetrics

Clinical risk management is key to improving the safety of care that we provide. In obstetrics, it is particularly important as it is a high-risk speciality, and the cost of mistakes is high, both financially and in human terms. Human error is inevitable, so there is a need to understand the theory of human error and the systems, rather than person-centred, approach to dealing with adverse events. Risk management has many components, including organisational culture, risk assessment, training, induction, guidelines, communication, audit, learning from adverse incidents, claims and complaints. For the future, the aim should be to move from risk management to a safety culture.

Clinical risk management in obstetrics: eclampsia drills.

Infrequent presentation of patients with eclampsia, leading to staff inexperienced in the condition and untested emergency systems. "Fire drill" programme using on-site simulation of patients with eclampsia. Tertiary referral obstetric unit. Successful implementation of measures to optimise management of eclampsia. Rapid activation of emergency team after one call, development and dissemination of evidence based protocol for eclampsia, strategically placed "eclampsia boxes," individual staff feedback and education. Efficient and appropriate management of subsequent simulated patients. On-site simulation can identify and correct potential deficiencies in the care of patients with eclampsia.

Clinical risk management in obstetrics.

Over recent years there has been a growing appreciation that a small but significant proportion of patients experience (sometimes serious) adverse events in the hands of health care workers. Although research in this area is very much in its infancy there has been an increasing move towards applying principles of risk management from industry to health care organizations. With the particularly disastrous and costly nature of adverse outcomes in obstetrics it is appropriate to review clinical risk management issues in maternity. This review explores the appropriateness of applying lessons learned in industry to maternity. The classification of errors into individual and latent, or organizational, is examined. Furthermore, the way in which these errors can be identified and subsequently analysed, with examples from maternity units in the UK and USA, is discussed. The importance of an educational and supportive environment, rather than a blame culture, for both reporting of incidents and learning from adverse outcomes is emphasized. Improvement in patient experience of health care rests not just with improved treatments, but also with a reduction in the adverse events which occur in health care institutions. The principles by which risk can be identified prospectively and retrospectively, and the mechanisms for both local risk management and regional/national reporting and learning are considered.

Clinical risk management in obstetrics: eclampsia drills

Problem Infrequent presentation of patients with eclampsia, leading to staff inexperienced in the condition and untested emergency systems.Design “Fire drill” programme using on-site simulation of patients with eclampsia.Setting Tertiary referral...

Risk Management and Litigation in Obstetrics and Gynaecology

Money paid out for clinical negligence now accounts for a sizeable part of National Health Service spending. The trend to litigation is increasing and the specialty of obstetrics and gynaecology suffers particularly because of high awards for brain damage in babies. Numerous books and courses offer advice on how to avoid such litigation, under the titles risk management and clinical governance. However, some clinicians feel that risk management is a drain on time and resources, without much benefit to the patient. This view, I believe, is partly due to a mistaken idea that risk management is synonymous with defensive medicine. Defensive medicine is a sloppy mode of practice whereby patients are overinvestigated so that the clinician escapes criticism if the outcome is unsatisfactory. (Most investigations yield some false-positives which then lead to further tests, which may be hazardous to the patient.) Risk management, by contrast, is about identifying the risks, deciding on practical strategies to minimize them and also deciding whether they are worth taking. Individuals and departments reach differing conclusions, hence the variations in management policies nationwide.

Risk Management and Litigation in Obstetrics and Gynaecology

Risk Management and Litigation in Obstetrics and Gynaecology

Risk management in obstetrics

Risk management is often considered to be a reactive process intent on responding to concerns about litigation. In reality, it is a dynamic process aimed fundamentally at improving the quality of patient care on a continuous basis. The rapid increase in the importance of risk management has come from the arrival of the Clinical Negligence Scheme for Trusts risk management standards. An ‘Organisation with a Memory’ targets a 25% reduction in obstetric litigation and the National Patient Safety Agency has arrived to develop adverse event reporting. The process involves risk identification from incidents or claims followed by an assessment of the severity of the risk and its root causes. Ideally, the process should be proactive considering the environment, staffing, communication and teamwork, patient care and discharge issues. Successful risk management depends on the culture of the organization. Staff must be confident that the system will avoid attributing blame to individuals.

Risk management in obstetrics

Risk management is often considered to be a reactive process intent on responding to concerns about litigation. In reality, it is a dynamic process aimed fundamentally at improving the quality of patient care on a continuous basis. The rapid increase in the importance of risk management has come from the arrival of the Clinical Negligence Scheme for Trusts risk management standards. An ‘Organisation with a Memory’ targets a 25% reduction in obstetric litigation and the National Patient Safety Agency has arrived to develop adverse event reporting. The process involves risk identification from incidents or claims followed by an assessment of the severity of the risk and its root causes. Ideally, the process should be proactive considering the environment, staffing, communication and teamwork, patient care and discharge issues. Successful risk management depends on the culture of the organization. Staff must be confident that the system will avoid attributing blame to individuals.

Managing Risk, Clinical Error, and Quality of Care

Clinical risk presents enormous challenges for the health profession and governments. Despite excellent national and regional programs focused on the management of obstetrical conditions and prevention of newborn injury, an environment of clinical error persists; according to Canadian Medical Protective Association data, each year 6% of Canadian obstetricians face a legal challenge, with most cases also involving nurses and hospitals. Principles and lessons learned from risk management developed in high reliability organizations (HROs), such as air traffic controllers and nuclear power plants, can be applied to risk management in perinatal/obstetrical units. In 2002, the Society of Obstetricians and Gynaecologists of Canada will launch an obstetrical risk management program called “Managing Obstetrical Risk Efficiently” (MORE), integrating labour and delivery clinical core content with HRO principles and reflective learning and practice modification tools designed to help all obstetrical caregivers build and maintain confidence and competency, improve patient safety and quality of care, and reduce clinical error and adverse events.

Risk Management and Litigation in Obstetrics and Gynaecology, Edited by Roger V Clements, London, The Royal Society of Medicine Press, Royal College of Obstetricians and Gynaecologists. 2001, pp 406, £29.95, ISBN1 8531 480 6 (Hardback)

Risk Management and Litigation in Obstetrics and Gynaecology, Edited by Roger V Clements, London, The Royal Society of Medicine Press, Royal College of Obstetricians and Gynaecologists. 2001, pp 406, £29.95, ISBN1 8531 480 6 (Hardback)

Applying human factors methods to clinical risk management in obstetrics.

Applying human factors methods to clinical risk management in obstetrics.

The role of placental examination and its pathology in obstetric risk management

The placenta is a marker of biologic events that occur during pregnancy. Placental pathologic examination gives insight to pregnancy-related insults, which affect the newborn at and after birth. Clinicians and risk managers can use this information to identify the cause of newborn complications in cases suggested to be birth-related injuries.

Safe Practice in Obstetrics and Gynecology

New York: Churchill Livingstone, Inc., 1995, 492 pp., $95.00. Department of Pathology Duke University Medical Center Durham, North Carolina 27710, U.S.A.

Current Topics in Obstetrical Risk Management—Part II

Current Topics in Obstetrical Risk Management—Part II

Reducing perinatal mortality in developing countries: high risk or improved labour management?

This study identifies obstetric conditions related to infant mortality examines the usefulness of maternal characteristics as predictors and evaluates obstetric risk management as a viable strategy for reducing infant mortality. The study was conducted from October 1 1988 to September 30 1989 in the representative small rural community of Santa Maria de Jesus Sacatepequez Guatemala. The community was comprised of primarily Cakchiquel Maya Indians and subsistence farmers living in houses with earthen floors. Female illiteracy was 39%. Interviews were conducted among mothers in the third trimester of pregnancy. Delivery data were collected within the first week after delivery. 437 births occurred during the study year and 27 infants died (62/1000). The completed sample includes 27 child deaths and 329 pregnant mothers with surviving births. Seven (26%) deaths occurred within 24 hours of which four were due to congenital abnormalities and three were depressed at birth and died within 12 hours. The remaining 23 deaths were potentially preventable. The characteristics of the mothers with infants who died included 30% with first pregnancies 30% with over three previous pregnancies 43% with prior complications in pregnancy outcome and 70% who were illiterate. The positive predictive values for these characteristics range from 0 to 0.13%. Combining risk characteristics increases the predictive value. The strongest predictors are mother aged under 17 years with a first birth (predictive value of 0.15) mothers with over six prior pregnancies and birth intervals of under 14 months (predictive value of 0.17). 14 (61%) of the 23 deaths involved fetal malpresentation and seven were associated with complications from prolonged labor. At least 20 of the 23 potentially preventable deaths were cases where the traditional birth attendants (TBAs) should have been able to detect problems and refer mothers for medical intervention. 73% of intrapartum/one day deaths (27 infants who died) and 18% of study births involved obstetric complications. The case fatality rate is 0.35. Findings suggest better training of TBAs in detection of fetal malpresentation (location of the fetal head) and a modified risk approach and referrals. The suggestions are contingent on transportation and cultural acceptance.

Risk management in obstetrics and gynaecology

When medical negligence claims in the fields of obstetrics and gynaecology are retrospectively analyzed, a distinction must be drawn between the categories of claims most likely to be submitted and those categories most likely to succeed.Although some types of injury may be difficult to avoid, too many successful claims are found to relate to medical acts and omissions which with due care could have been avoided. A programme of risk management should concentrate on improved communication with patients (including the correct transmission and assimilation of data), better counselling (including the advice and information underlying informed consent), measures to ensure clinical competence (including caution in delegation to juniors and wider use of referral to senior staff) and the enforcement of well-devised rules for the maintenance of patient records.

Professional liability risk management and incident management in obstetrics

Professional liability risk management and incident management in obstetrics