Steven L. Clark, MD, Michael A. Belfort, MD, PhD, Spencer L. Byrum, LCDR (ret.) USCG, Janet A. Meyers, RN, Jonathan B. Perlin, MD, PhD
Received 16 October 2007; received in revised form 26 November 2007; accepted 14 February 2008. published online 12 May 2008.
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.