The American Journal of Obstetrics and Gynecology, May 2, 2009, Volume 200, Number 5, publishes the results of a study conducted in partnership by the Department of Obstetrics and Gynecology Reproductive Science, Yale University School of Medicine, and Yale-New Haven Hospital. This study was designed to determine whether a comprehensive patient safety strategy to prevent obstetrical adverse events can have an impact.
Remarkably, the malpractice liability carrier for the institutions supported the cost of the outside expert review and the patient safety nurse and her initial training and crew management training and education.
The authors focus on the average payment for an obstetrical liability claim ranging between $500,000 and $1,900,000 and assert that such a premium has dwarfed the costs of maintaining an annual program directed at comprehensive patient safety ($150,000).
Their study proves that attention to patient safety makes a difference. During the study period, the number of adverse incidents was reduced by nearly 1/3. The improvement in patient safety during this study period resulted from the institution of an educational program that included dissemination and review of the National Institute of Child Health and Human Development Guidelines, review of monitor tracings, allocation of study guides and voluntary review sessions. All medical staff and employees responsible for electronic fetal monitoring interpretation were obliged to take an examination to demonstrate their competence, rather than such competence being assumed.
Throughout the United States lawyers representing victims of obstetrical malpractice have identified for years patients needlessly injured as a consequence of inadequately trained and supervised personnel misinterpreting maternal and fetal monitoring or failing to act appropriately in response to the interpretations made.
That the motivation for the implementation of the new safety protocols was purely economic, it certainly provided a substantial payoff in improved outcome for patients. While we might all prefer that patient outcome would be more important than concern about malpractice premiums, this study provides yet another example of both the need for and the value of our legal system in motivating the provision of improved health care.