A call for safety: Anticipating and mitigating risk across an obstetrics and gynecology service line.

Delivery of healthcare is a complex interaction of patients, healthcare providers, nurses, ambulatory practices, and hospitals. As the model of health care transitioned, free standing physician practices and hospitals have coalesced to form networks of ambulatory practices and hospitals. This change in the model of healthcare delivery presented challenges to provide safe, quality, cost-effective care for patients, with potentially increased risk to an organization. The development and imbedding of comprehensive safety strategies are imperative to the foundation of this model. Northwell Health, a large health system in the northeastern United States developed a strategy for their Obstetrics and Gynecology Service Line which includes weekly interaction by departmental leadership from each hospital to discuss operations, share concerns and identify potential opportunities to prevent recurrent suboptimal outcomes and improve patient safety. The weekly Safety Call, described in this article is a component of the safety and quality program that has contributed to a 19% decrease in the Weighted Adverse Outcomes Index for the 10 maternity hospitals delivering over 30,000 babies annually within the system since inception. There was also a significant reduction in insurance premiums based on actuarial projections of risk reduction because of the implementation of an Obstetrical Safety Program.

The care of pregnant women during the COVID-19 pandemic - response of a large health system in metropolitan New York.

The rapid progression of the coronavirus disease 2019 (COVID-19) outbreak presented extraordinary challenges to the US health care system, particularly straining resources in hard hit areas such as the New York metropolitan region. As a result, major changes in the delivery of obstetrical care were urgently needed, while maintaining patient safety on our maternity units. As the largest health system in the region, with 10 hospitals providing obstetrical services, and delivering over 30,000 babies annually, we needed to respond to this crisis in an organized, deliberate fashion. Our hospital footprint for Obstetrics was dramatically reduced to make room for the rapidly increasing numbers of COVID-19 patients, and established guidelines were quickly modified to reduce potential staff and patient exposures. New communication strategies were developed to facilitate maternity care across our hospitals, with significantly limited resources in personnel, equipment, and space. The lessons learned from these unexpected challenges offered an opportunity to reassess the delivery of obstetrical care without compromising quality and safety. These lessons may well prove valuable after the peak of the crisis has passed.

Risk Management in Obstetrics and Gynecology.

This article will review the basic principles of risk management, the role of the risk manager, and the importance of risk management in the patient safety movement as it pertains to obstetrics and gynecology. Several tools that are used by risk managers including risk assessments and root cause analyses will be used to illustrate positive patient safety measures that can be initiated to decrease adverse outcomes and reduced risk to an organization. The dramatic reduction in adverse outcomes and claims after the introduction of patient safety initiatives in a major obstetrical service will be reviewed.

A new frontier in healthcare risk management: Working to reduce avoidable patient suffering.

This article presents a new avenue for healthcare risk managers to drive improvement for patients and healthcare organizations alike: working to reduce avoidable patient suffering. It briefly describes the problem of patient suffering, differentiates between avoidable and unavoidable suffering, and suggests that common risk management tools can be used to tackle the problem. It also highlights a success story from one large health system.

Pearls of wisdom: practical application of the Pearls Series.

Scores of ASHRM members have collaborated to produce the Pearls Series, a set of pocket guides on topics of interest for not only risk managers but also administrators, clinicians, and board members. The succinct format facilitates the dissemination of pertinent information to a wide audience. Risk managers should be knowledgeable of the Pearls topics, understand how to develop appropriate metrics, and manage the monitoring and performance improvement aspects that are critical to ensuring successful knowledge transfer.

TeamSTEPPS and patient safety in healthcare.

Communication problems in healthcare are considered to be a leading cause of medical errors and often the root cause of sentinel events. This article will review the implementation of TeamSTEPPS in the two large health systems. The challenges in the implementation process, the successes, failures, and the obstacles will be discussed. Comparisons between the systems as well as lessons learned after implementation will be reviewed to enable hospitals and health systems to implement and sustain a successful TeamSTEPPS program.