It is not possible to prevent every birth-related lawsuit or adverse outcome but it is possible to attack the controllable factors that contribute to birth-related injuries. See part 1 on detecting an infant in distress, part 2 on delays in cesarean sections and part 3 on shoulder dystocia section. Here are some of the strategies that are working.

Define and use evidence-based care bundles. “Evidence-based” refers to using the results of the best current reliable studies to make decisions about the care of patients. “Care bundles” are collections of processes needed to effectively and safely care for patients undergoing a certain type of care. The care bundles provide specific clinical care steps for providers to follow. The hospital’s policies and procedures should be patterned after these care bundles and best practices. This fosters an organizational culture that promotes patient safety.
The Institute for Healthcare Improvement has these bundles: Elective Induction, Augmentation and Vacuum. Each consists of 4-5 best practices that providers should follow. For example, the Elective Induction bundle advises to healthcare providers to look for these parameters:

• Gestational age equal to or greater than 39 weeks
• Normal fetal status (per NICHD tiers) prior to onset of oxytocin
• Pelvic exam prior to the onset of oxytocin
• Recognition and management of tachysystole

Provide training to enhance communication and teamwork. These factors are critical for patient safety and reducing preventable adverse events. Training workshops and support help the team function well. The staff should be using a common language to describe the condition of the fetus during labor and focus on excellent communication with each other and with the patients. Many facilities use TeamSTEPPS as a teamwork system originally developed by the Department of Defense in collaboration with AHRQ. Its goal is to produce highly effective teams to achieve excellent clinical outcomes.

SBAR is useful for creating a standard format for communication.It is often used in urgent situations as well as during the time providers transfer care of a patient or when a nurse contacts a physician. The healthcare provider defines the Situation, gives ZBackground, provides an Assessment and makes a Recommendation.

Use simulation exercises. This gives teams a chance to practice responding to emergencies. These are particularly useful exercises to teach skills needed for events that occur infrequently. Teams also practice how to handle life-threatening situations. There’s no risk to a patient during a simulation. Mannequins or actresses are used. After the simulation is over, a debriefing period provides the team with critical information on their performance and helps to improve care. Debriefing is also useful for routine deliveries. It encourages continuous improvement.

Employ an obstetrical rapid response team. These individuals react to a crisis, assess the clinical situation, and mobilize resources to help the patient. Read more about rapid response teams.

Obstetrical cases may involve huge injuries. Any prevention effort can yield enormous savings in money and suffering.

Med League supplies well-qualified obstetrical as well as other experts. Contact us for help with your next case.