Hospital cuts medmal 50% in obstetrics

A Connecticut hospital saw a 50% drop in malpractice liability claims and payments when it made patient safety initiatives a priority by training doctors and nurses to improve teamwork and communication, hiring a patient safety nurse, and standardizing practices, according to a study by researchers at the Yale School of Medicine in New Haven, CT.

The results, published in the June 9, 2014, online issue of the American Journal of Obstetrics and Gynecology, come at a time when mounting concerns about liability are thinning the ranks of obstetricians in the United States, says author Christian Pettker, MD, associate professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.

"Liability insurance rates are not controlled, malpractice awards continue to increase, and there is increasing awareness of litigiousness in clinical practice," Pettker says. "As a result, obstetricians are increasingly reducing or dropping out of practice, and future physicians are discouraged from entering the field."

In 2004, Pettker and his team partnered with their liability insurance carrier to conduct a comprehensive safety assessment.

The team then made improvements to the healthcare system and culture by standardizing care, learning and practicing new teamwork protocols, and enhancing oversight of clinical work. The hospital hired a patient safety nurse, for example, and established specific ways in which clinicians would work as a team to care for an expectant mother and child.

Comparing two time periods

The team compared the five-year period before the safety program was implemented to the five-year period afterward.

"We found a 50% reduction in liability claims and also found that the payments made for these liability claims decreased 95%, from over $50 million to under $3 million," Pettker says.

In two prior studies, Pettker and his team found that the same safety-improvement program reduced adverse outcomes and created an improved culture of safety on obstetrical units. "This new publication demonstrates yet another positive result of our program," he said. "We’ve found that standardizing care, improving teamwork and communication, and optimizing oversight and quality review reduces liability exposure."

Pettker says that while most of the measures in the hospital’s program make sense to outside observers, some involve substantial and systematic changes that might be resisted by nurses and doctors who value individual knowledge, skills, and experience.

"We don’t think that this is a cure to the medical liability crisis, but this is certainly one approach that can both make things safe for the patient and have tremendous improvements and reduce a lot of the costs in healthcare that go to the defense of medicine and liability," Pettker says.

Source

• Christian Pettker, MD, Associate Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT. Telephone: (203) 785-3091. Email: Christian.pettker@yale.edu.