ful implementation of patient safety initiatives and will need to be addressed, Miller noted: time it is made. "Getting lucky is not the same thing as good practice," Miller said. to the concepts of "groupthink," herd behavior, and manias. Many common birth practices are related to this bias. Miller said. The entire health care team, including clinicians, needs to be open to recognizing their limitations and knowledge gaps, and embrace the idea of proving competency, using ongoing training to force habituation of their skills. strengths and weaknesses as clinicians. Next, we need to look at our institutions and systems: Where are our knowledge gaps? What areas need improvement? At the broader level, we need to begin to look at statewide health and health disparities. And most importantly, we must engage our communities--patients and families that are our neighbors, our friends, and our shared responsibility when it comes to safety," Miller said. national--for ideas on improving safety, she added. California, Illinois and New York, for example, have developed exemplary programs in the reduction of maternal mortality and morbidity, secondary to hemorrhage, she noted. In addition, the March of Dimes' 2012 Premature Birth Report Card grades the 50 states by comparing each state's rate of preterm birth to the organization's 2020 goal of 9.6 percent. Look at what Oregon is doing, for example, that earns its preterm birth rates an "A" grade. It is important to look at report cards such that local hospitals and health organizations can use them as a self-assessment tool by which to find areas for improvement. organization is also extremely important, and taking patient volume into account may be a factor, Miller said, as the CRICO Strategies' 2010 Annual Benchmarking Report showed variation in the percent of liability cases based on hospital volume. For example, delay in treatment of fetal distress was more common in hospitals with fewer than 2,000 births per year compared to hospitals with higher volume (25 percent vs. 19 percent, respectively), while improper management of pregnancy was more common in cases among hospitals that have more than 2,000 births per year. maternal mortality has proven to be effective in reducing risk and improving outcomes, said Miller. A study in Obstetrics & Gynecology patterns, including in-house obstetrical coverage and protocols for medication, shoulder dystocia, and vaginal births after Cesarean delivery. "still a way to go," she said. of medical and nursing error. Our next goals must include involving and educating the consumers of perinatal care, and evaluating the evidence that is based on patient outcomes," Miller said. "Physicians and nurses also need to look at sharing information across disciplines, and using each other's literature jointly when creating educational programs." |