Near-miss reporting and the OB Right program.(MASTER CLASS)

Hospital safety issues have been widely reported and have received significant attention recently. However, solutions have been slow in coming. Thus, the ongoing challenge of creating the safest labor and delivery environments possible has been left with obstetricians. Although the problem is daunting, there are many steps that obstetric and gynecologic practices can take on their own that will reduce adverse events in labor and delivery as well as optimize maternal-fetal outcomes.

Separate reports published almost a decade ago by the Institute of Medicine and the American Hospital Association estimated that 44,000-98,000 patients die each year from errors made during hospital stays.

That higher death rate accounts for almost double the number of people who die in motor vehicle accidents each year in this country, and double the number of women who die annually from breast cancer, according to the Centers for Disease Control and Prevention.

The problem is so severe that Dr. Mark R. Chassin, president of the Joint Commission (an independent, not-for-profit organization that accredits and certifies more than 15,000 health care organizations and programs in the United States), noted recently that the chance of any of us being injured from simply being in a hospital and not as the result of an illness is 40% greater than the likelihood of an airline mishandling our luggage.

The problem of inconsistent and dysfunctional clinical patterns of care in both the inpatient and outpatient settings is even more alarming. One large study involving the review of 18,000 patients received care in keeping with current best practices ("Epidemic of Care: A call for Safer, Better, and More Accountable Health Care." San Francisco: Jossey-Bass, 2003).

Approximately 5 years ago, the Joint Commission examined all perinatal "sentinel" events across the country in all types of institutions, and found that 72% of such events were linked to break downs in communication.

Other identified root causes included staff competency (47%), staff orientation and training (40%), inadequate fetal monitoring (34%), unavailable equipment or drugs (30%), and physician-credentialing issues (30%).