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."