Impact of a comprehensive patient safety strategy on obstetric adverse events

Am J Obstet Gynecol. 2009 May;200(5):492.e1-8. doi: 10.1016/j.ajog.2009.01.022. Epub 2009 Feb 27.


Objective: We implemented a comprehensive strategy to track and reduce adverse events.

Study design: We incrementally introduced multiple patient safety interventions from September 2004 through November 2006 at a university-based obstetrics service. This initiative included outside expert review, protocol standardization, the creation of a patient safety nurse position and patient safety committee, and training in team skills and fetal heart monitoring interpretation. We prospectively tracked 10 obstetrics-specific outcome. The Adverse Outcome Index, an expression of the number of deliveries with at least 1 of the 10 adverse outcomes per total deliveries, was analyzed for trend.

Results: Our interventions significantly reduced the Adverse Outcome Index (linear regression, r(2) = 0.50; P = .01) (overall mean, 2.50%). Concurrent with these improvements, we saw clinically significant improvements in safety climate as measured by validated safety attitude surveys.

Conclusion: A systematic strategy to decrease obstetric adverse events can have a significant impact on patient safety.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cesarean Section / statistics & numerical data
  • Episiotomy / statistics & numerical data
  • Female
  • Humans
  • Medical Errors / prevention & control
  • Obstetric Nursing / organization & administration
  • Obstetrics / organization & administration
  • Obstetrics / standards
  • Obstetrics and Gynecology Department, Hospital / organization & administration*
  • Obstetrics and Gynecology Department, Hospital / standards*
  • Patient Care Team / organization & administration
  • Pregnancy
  • Professional Staff Committees / organization & administration
  • Program Evaluation
  • Risk Management / organization & administration*
  • Safety Management / organization & administration*
  • Staff Development / organization & administration
  • Surveys and Questionnaires