Tuesday, September 16, 2008

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

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.

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