Throughout the country, pregnancy and birth-related claims top the list in indemnity expense. Historically, obstetrics leads other specialties in the total dollars spent in malpractice claims. Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims. According to the Physicians Insurers Association of America (PIAA) Data Sharing Project—the largest sources of medical malpractice data in both the United States and the world—brain damaged infant is the most prevalent and expensive condition of all paid claims.

A significant cultural change is needed in the way that perinatal care is delivered. The greatest opportunity to mitigate perinatal risk is found in a culture that supports a learning environment, where incident trends are analyzed and learning opportunities shared with the multidisciplinary team, and where each member of the team is valued.

In an effort to meet these challenges, Clinical Risk Solutions, Inc. provides on-site comprehensive perinatal clinical risk assessment, a proven methodology to achieve a patient safety-centered model of excellence.

Following a pre-assessment telephonic leadership interview, a two- day, on-site assessment is conducted. A prioritized plan of improvement, resource tool kit, and educational sessions are included within the scope of the initiative.

The Perinatal Service on-site assessment includes a review of the following areas:

Organizational Leadership:
  • Culture of patient safety, communication, team cohesiveness
  • Organizational structure, leadership, strategic plan
  • Focus interviews with key stakeholders and medical staff leadership team
  • Adverse event management process, data analysis, professional liability claims review
Medical staff and nursing competency:
  • Medical staff credentialing, peer review, and physician performance evaluation
  • Effectiveness of medical staff leadership, committee structure, documentation, and communication
  • Clinical staffing ratios, nursing credentialing, and competency assessment
Quality/patient safety departmental initiatives:
  • Clinical practices, policies, and procedures
  • Triage, screening, examination, admission, and discharge of the obstetrical patient
  • Select policy review-informed consent, procedural sedation, physician order sets, emergency management of high-risk patients, triage management, maternal/neonatal transfer, medical screening, induction of labor, FHR assessment, placenta previa, placenta abruption, postpartum hemorrhage, trauma with pregnancy, neonatal resuscitation, chain-of-command, forceps/vacuum, pregnancy induced hypertension, disruptive behavior, anesthesia, and delineation of perinatal privileges
  • Perinatal interface with Diagnostic Imaging, Laboratory, OR, and ED
  • Clinical documentation/assessment tool review