Obstetricians take big steps to avoid malpractice

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Delivering babies can be a high-stakes undertaking for hospitals, with the threat of multi-million-dollar malpractice damages when serious mishaps occur. But a team of Manhattan obstetricians says it has beaten the odds—dramatically reducing errors and slashing their department's medical malpractice payouts by more than 99%.

“Any hospital could do it—it's not about money, it's about changing the culture to make it safer to deliver babies,” ...

The new measures reduced errors and helped ward off unwarranted suits by clearly documenting everything doctors did right in cases where a bad outcome was not their fault ... these safety initiatives reduced so-called “sentinel events"—such as avoidable deaths and serious injuries—to zero in 2008-09, down from five in 2000.

Consumer advocates are hailing the report as a breakthrough in patient safety and a better way to curb malpractice costs than tort reform. “People don't get sued if they don't get hurt,” ...

... the safety changes resulted in annual medical malpractice payouts dropping from an average of a $28 million from 2003 to 2006 to $2.6 million a year from 2007 to 2009. With no sentinel events reported in 2008 and 2009, those totals are expected to drop still further.

Among the easier changes was doing away with the labor and delivery unit's dry-erase whiteboard, which staff used to communicate patients' progress ...

Instead, the team came up with a new electronic application to do the same job better, a record that can be accessed through any Internet browser. No paper charting is allowed, both for improved communication and with an eye to leaving a clear legal record in case of a poor medical outcome.

Some of the staffing changes cost money. The unit hired a full-time patient safety nurse to educate staff on new protocols the doctors wanted and to conduct emergency drills, such as what to do when a mother started to hemorrhage ...

Reasoning that doctors tend to make mistakes when they are deprived of sleep, the department hired three physician assistants and a “laborist,” which is a new term for an obstetrician who works for a hospital full-time, instead of just having admitting privileges there. At Weill Cornell, the laborist works nights and weekends, reducing the time other obstetricians need to be “on call” in their off hours.

Though many aspects of the plan were costly, the authors concluded that the savings in medical malpractice payments "dwarf the incremental cost of the patient safety program.”

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