The high-risk, high-liability clinical practice of obstetrics is at the pivot point of patient safety and medical liability. Its outcomes extend across life-times and through generations;emotionally and economically its consequences reverberate long and deeply within families, health care providers and society. Those who work in the field of obstetrics are active participants in mankind's most life-affirming moment. They understand the price of error - a new life denied or irreparably damaged. This understanding - in the broadest, yet most meaningful sense - is why Ascension Health has chosen obstetrics as the focus of our demonstration project in linking patient safety to medical malpractice reform. Ascension Health, the nation's third largest health System aims to demonstrate that implementing principles of High Reliability will lead to significantly improved patient safety and reduced medical liability in the high-risk practice of obstetrics. This will be accomplished using an innovative model to simultaneously implement 1) an improved medical liability response model and 2) uniform, evidence-based care in five test sites. The ultimate goal is to translate program success to other clinical practice areas in order to reduce preventable patient harm to zero. These goals will be pursued through the following specific aims: 1) Establish a uniform evidence-based obstetrics practice model based on the idea that eliminating variability in obstetrics practice will translate to improved patient safety. Activities include standardized training for all obstetrics team members in the principles of High Reliability. Team members also will undergo standardized training in electronic fetal monitoring, birthing emergency simulation training and training in the use of an evidence-based bundle designed to minimize injury from shoulder dystocia. The goals are to improve patient care through uniform, best-practices and improved team communication. 2) Implement a quick-response liability model, which will include standardized practices for identifying, responding to, investigating and disclosing medical errors. This is based on the belief that a quick response and early resolution of cases with apparent liability will minimize the frequency and severity of medical liability claims. The central component will be establishing an Obstetrics Emergency Response Team at each test site that will be uniformly trained on how to respond to emergencies, communicate with patients/families and conduct apparent and root cause analyses. 3) These activities will be supported with standard processes for data collection, storage and analyses. The centerpiece here is the Ministry Intelligence Center (MIC), which is an IT infrastructure that delivers Business Intelligence capabilities. It will consist of portals, dashboards and data warehouses that will provide target sites and central administration with Key Performance Indicators and also allow ad hoc data queries and predictive modeling capabilities. MIC's technical infrastructure consists of a data aggregation layer which will extract data from various sources (obstetrical events, related claims, and Electronic Health Record systems), which are sent through a Lexical/Data Normalization process before going into a Clinical Data Repository. This normalization allows mapping of these data to standards like SNOMED_CT or ICD9/10 in order to conduct comparative analytics across the test sites that have different IT infrastructures. These large amounts of data that will be collected will be combined and stored in the enterprise data warehouse for later analysis that will be done in collaboration with Brandeis University. Lessons learned from these data analyses will be used to identify ways to further improve clinical care and reduce the frequency of liability claims until the goal to provide excellent clinical care with zero preventable injuries is achieved.
The applicant, Ascension Health, has an ongoing commitment to making organizational and cultural changes necessary to provide excellent healthcare with zero preventable errors. This application proposes a two-pronged strategy to make this happen in obstetrics units at test sites by instituting: 1) an improved and uniform medical liability response model and 2) new, evidence-based and uniform obstetrical practices. The goal is to create a High Reliability Organization at the test sites that will enhanced patient safety and reduce the number and severity of medical liability claims.
| Harter, Georgia; Darden, Jennifer; McMenemy, Nancy et al. (2016) Consent and enrollment process: achieving high enrollment rates for obstetric research. Appl Nurs Res 29:101-6 |
| Burstein, Paul D; Zalenski, David M; Edwards, John L et al. (2016) Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes. Health Serv Res 51 Suppl 3:2472-2486 |
| Santos, Palmira; Ritter, Grant A; Hefele, Jennifer L et al. (2015) Decreasing intrapartum malpractice: Targeting the most injurious neonatal adverse events. J Healthc Risk Manag 34:20-7 |
| Hendrich, Ann; McCoy, Christine Kocot; Gale, Jane et al. (2014) Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise. Health Aff (Millwood) 33:39-45 |
