The American College of Obstetricians and Gynecologists announced plans to meet national patient safety standards while combating soaring malpractice rates with strategies learned from another high-risk profession — commercial and military aviation.The safety plan focuses on three items: improving communication with nurses, better teamwork and tracking of medical tests, and clearer handwriting of prescriptions and patient care directions.
The President of ACOG, Dr. John M. Gibbons, Jr., announced the proposed reforms during his opening remarks at the society’s Annual Clinical Meeting in Philadelphia earlier this month. He stated that the need for patient safety reform and reform of the medical liability system were top issues for ACOG.
The need to improve patient safety across all medical professions received national attention in 1999 after publication of an Institute of Medicine (IOM) report which estimated that 1 million people are injured every year by errors in treatment at the nation’s hospitals. As many as 98,000 deaths occur as a result of medical errors. That’s a death rate 1,000 times greater than the rate of commercial airline accidents.
Dr. Stanley Zinberg, ACOG Vice President, pointed out that most of the medical errors cited in the IOM report were not related to individual physician competency—which is the focus of the current medical tort system—but instead were the result of system-wide failures. Such failures include poor communication between hospital departments and personnel, failures in identifying and tracking patients, and failures in dispensing medication due to poor handwriting, confusing abbreviations, or similar drug names.
Many states have seen a decline in the numbers of Ob-Gyn’s willing to practice medicine in their states due to rising malpractice insurance costs. ACOG hopes to address this issue and help its physician members due their part to reduce medical mistakes by drawing on the best safety practices of the aviation industry. By applying the techniques of Crew Resource Management (CRM), which the Federal Aviation Authority has mandated for all commercial airlines since 1997, ACOG hopes to make childbirth and other gynecological procedures less risky.
CRM techniques were developed after NASA found that human error and failures of communication were involved in a majority of aviation accidents. Rather than blaming individuals when something goes wrong, CRM encourages open-reporting and analysis of the problem to improve processes in the organization. The Institute of Medicine speculates that such teamwork and open communication will reduce medical errors in high-stress environments such as labor and delivery rooms.
So far the CRM approach to medicine appears to be working. Dr. Benjamin P. Sachs, chief obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston told members at the ACOG meeting that the rate of adverse outcomes in obstetrics has declined 53% in the last four years at his hospital. They are still awaiting outcomes of this team training study which involves 15 civilian and military hospitals employing the techniques of CRM. Dr. Sachs’ observations of the use of CRM in his own institution led him to conclude that better communication and teamwork can make childbirth safer.
