Clinical opinion
Obstetrics
Improved outcomes, fewer cesarean deliveries, and reduced litigation: results of a new paradigm in patient safety

https://doi.org/10.1016/j.ajog.2008.02.031Get rights and content

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.

Section snippets

The problems

  • 1

    Despite spending more of our gross domestic product on health care than any other industrialized country, the United States currently ranks 17th in the world in perinatal mortality rate, outcomes that, according to the World Health Organization, are largely due to obstetric causes.1 While there are certainly demographic differences between the United States and some of the world's countries with better perinatal outcomes, we have found it increasingly difficult to accept such differences as the

Our approach

Beginning in the year 2000 and continuing to the present date, HCA has evolved and implemented a unique, integrated approach to these issues, in conjunction with a clinical advisory board and work group consisting of practicing physicians and nurses at our facilities. This approach is based on the following 5 principles:

  • 1

    Uniform processes and procedure result in an improved quality, including medical care. As a corollary, process variation generally leads to poor quality.

  • 2

    Every member of the

References (24)

  • R.W. Hale et al.

    Elective prophylactic cesarean delivery

    ACOG Clin Rev

    (2005)
  • R. Resnik

    Can a 29% cesarean delivery rate possibly be justified?

    Obstet Gynecol

    (2006)
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    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.

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