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

Am J Obstet Gynecol. 2008 Aug;199(2):105.e1-7. doi: 10.1016/j.ajog.2008.02.031. Epub 2008 May 12.


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.

MeSH terms

  • Cesarean Section / statistics & numerical data*
  • Clinical Protocols* / standards
  • Evidence-Based Medicine
  • Female
  • Humans
  • Malpractice / statistics & numerical data*
  • Misoprostol / administration & dosage
  • Obstetric Labor Complications / prevention & control
  • Obstetrics / methods
  • Obstetrics / organization & administration
  • Obstetrics / standards
  • Outcome and Process Assessment, Health Care*
  • Oxytocics / administration & dosage
  • Peer Review
  • Pregnancy
  • Pregnancy Outcome*
  • Quality of Health Care
  • United States


  • Oxytocics
  • Misoprostol