A multihospital system's initiative to reduce obstetrical high-risk events was effective in decreasing events at its 37 hospitals immediately after the initiative's introduction and continued to lower adverse events once the initiative had been fully adopted. In an article published August 24, 2018, in the Journal of Healthcare Risk Management, the researchers identified the key elements to sustaining the initiative's success. The multihospital system adopted interventions to reduce events associated with shoulder dystocia and ineffective use of electronic fetal monitoring, which contribute to high rates of long-term neonatal injury and malpractice liability. The interventions included new protocols for addressing shoulder dystocia and abnormal or indeterminate fetal heart rate tracings, simulation and team-based training, and a rapid reporting and patient disclosure program for unplanned events. The system tested the initiative at 5 beta sites before expanding the program to another 32 hospitals. At both the beta and the expansion sites, high-risk occurrence rates per 1,000 live births decreased over a 66-month period after the intervention by more than 70%, compared with the rate during a 15-month intervention period. The high-risk occurrence rates dropped 59% and 47% at the beta and expansion sites, respectively, during the first 27 months after the intervention and continued to drop for an overall decrease of 78% and 71%, respectively, for the full 66 months after the intervention. The researchers attributed the sustained success of its obstetrical initiatives to ongoing use of evidence-based guidelines, leadership buy-in and support, monthly reporting of performance measures, ongoing training, and open discussion of barriers and remedies related to the interventions at both facility and system levels. Noting the difficulty healthcare organizations have had in sustaining improvement initiatives, the study authors said quality improvement initiatives "would benefit from considering the key elements that allowed [the multihospital system] to successfully sustain and spread the initiative and its benefits."

HRC Recommends: Successful efforts are emerging within healthcare and among professional liability insurers to support patient safety, reduce preventable errors and adverse outcomes, and reduce malpractice litigation—by identifying best practices and implementing new approaches to safe patient care. Risk managers and quality assurance and improvement departments can work synergistically to develop perinatal patient safety programs based on an analysis of the organization's adverse outcomes and reportable events data.