Early warning system promotes OB safety

Crico Strategies, the medical malpractice company owned by and serving the Harvard medical community in Cambridge, MA, recommends these remedies for the common causes of obstetrics (OB) claims:

• An early warning system for perinatal adverse event reporting.

To promote safer, high quality care of obstetrics patients, the Harvard-affiliated obstetrics leaders turned to consistent, systematic institutional reporting of six categories of perinatal adverse events:

— maternal death;

— uterine rupture/scarred uterus;

— retained foreign object;

— 5 minute Apgar score ≤ 4, term infant, ≥ 2,500 g;

— brachial plexus injury;

— intrapartum death of a term infant, ≥ 2,500 g; neonatal death of a term infant, ≥ 2,500 g, no congenital anomalies.

Review of these signal data support a proactive effort to facilitate more timely improvements in obstetrical care across Harvard's perinatal units.

• Premium incentives to reward improvement efforts.

Crico-insured obstetricians and certified nurse midwives who regularly participate in a series of patient safety education activities qualify for a significantly less costly malpractice insurance premium category than non-participants. The key requirements: a team training course, study of Crico's OB Guidelines, participation in safety drills, and completion of shoulder dystocia and electronic fetal monitoring CME courses. More than 90% of eligible obstetrical care providers participate.

• OB clinical guidelines to encourage best practices.

Published since 1988 and aimed at the most prominent issues seen in obstetrics-related malpractice claims, the "Clinical Guidelines for the Obstetrical Services of the CRICO-insured Institutions" are a codification of best practices and recommendations of the American College of Obstetricians and Gynecologists, and "Guidelines for Perinatal Care" of the American Academy of Pediatrics.

• Crew resource management.

A structured analysis of 10 years of OB claims indicated that 42% of those cases could have been prevented or mitigated with better teamwork. These data led to the development of Team Performance Plus (TPP), based on the elements of crew resource management, expanded and customized to the unique obstetrics environment. TPP trains to the specific skills of high performance teams: leadership, communication, shared vision, and error-reduction strategies. The program provides the structure and tools needed to effectively implement and sustain those skills, ensure leadership support, and manage roadblocks and resistance. (For more on these remedies and other resources for addressing OB claims, go to www.rmf.harvard.edu and select "high risk areas" at the top of the page. Then choose "obstetrics.")