Practice of Medicine


Steep Rise in Childbirth Complications: Implementing Training and Protocols to Improve Perinatal Safety

A December 2012 Wall Street Journal (WSJ) article highlighted increased risks associated with childbirth and actions being taken to improve patient safety in this area. It cited a study by the Centers for Disease Control and Prevention, that showed maternal emergencies during delivery such as cardiac arrest, res-piratory distress and kidney failure have increased 75 percent in the decade that ended in 2009.

Obstetrics-related complications account for $17.4 billion in annual U.S. hospital costs, according to the Agency for Healthcare Research and Quality (AHRQ). The WSJ article profiles one hospital system’s journey to improvement through their perinatal safety initiatives.

So when your patients ask what you and your hospital are doing to improve perinatal safety, what will your answer be? Hopefully, that you have instituted team training, clinical protocols, and simulations and drills as the hospitals described in the article did.

Teamwork, standardization, checklists, simulations, and drills have been shown to be useful in other fields, such as the military and airline industry. Unfortunately, health care has been slow to adopt these processes. But, we have seen positive change in how health care has evolved from being more of an individual endeavor to one focused on teamwork. Research has shown that these things can save lives and promote patient safety.   Teamwork and good team communication are vital for any patient safety initiative, but to implement these properly, there needs to be effective training. One example of team work training is TeamSTEPPS, an initiative based on evidence derived from team performance leveraging more than 25 years of research in military, aviation, nuclear power, business and industry to acquire team competence. An example of standardized communication utilized in TeamSTEPPS is SBAR (Situation, Background, Assessment and Recommendation), an approach to quickly and concisely convey important information to other team members. For further information on TeamSTEPPS, please see its website: In addition to teamwork and good communication, it is important that standardized protocols are in place for responding to obstetric emergencies. Just as we have protocols for neonatal resuscitation, we should have protocols for postpartum hemorrhage and other obstetric emergencies. This enables the team to know in advance what each member’s role is in a given situation.

It is also important that all of the tools that one needs for a given emergency are easily accessible. After all, how often does one need a Bakri balloon? Unfortunately, many times no one remembers where it is. A box or a cart with all the needed medications and equipment to deal with a postpartum hemorrhage can be very helpful. Easily accessible written protocols and checklists are of paramount importance, as is the team’s knowledge of and regular review of them.

Last, but definitely not least, it is important that teams practice to be sure that everyone is ready to jump in and do his or her job when one of these low-frequency, high-severity situations arises. Simulation and drills by the entire health care team are important so that the response becomes almost second nature.

Ultimately, the goal is that when a patient asks what you and your medical team are doing to improve patient safety in obstetrics you will be able to respond that you have: • Developed good teamwork • Focused on communication among team members • Implemented standardized protocols • Conducted regular simulations and/or drills to ensure that team members are ready to respond if an emergency occurs.

Created by MagMutual from materials provided by COPIC as part of MagMutual and COPIC’s alliance to improve patient safety and quality of care for all of our PolicyOwners.


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The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.