Influence of a Patient Safety Initiative on Perinatal Outcomes and Safety & Teamwork Climate

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Conference Proceeding

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Background: Physicians and nurses from the University of Rochester Medical Center partnered with their malpractice insurance carrier to implement the Obstetric Patient Safety Initiative consisting of six components. Goals were to improve obstetrical care and staff attitudes/behaviors related to patient safety and teamwork; and to decrease preventable adverse outcomes and malpractice claims losses for obstetrical patients.

Aim and objectives: Measured was the influence of the Obstetric Patient Safety Initiative on adverse perinatal outcomes, and on staff perception of patient safety and teamwork climate. Compared were 1) Adverse Perinatal Outcomes: pre/post-initiative scores including Adverse Outcome Index (AOI), Weighted Adverse Outcome Score (WAOS), and Severity Index (SI); 2) Staff Perception of Safety and Teamwork Climate: pre/post-initiative scores including safety climate and teamwork climate subscales of the Safety Attitudes Questionnaire (SAQ).

Methods: Descriptive one-group pre/post-intervention design incorporating retrospective chart review and survey data.

Analysis and Results: Independent-samples t tests determined statistically significant differences in pre/post-safety initiative AOI, WAOS, and SI scores (SAQ analysis is pending). Statistically significant differences were found in the percent of deliveries with one or more adverse events measured by the AOI (decreased), and the average severity of each delivery with an adverse event measured by the SI (increased). There was not a statistically significant difference in the adverse event score per delivery measured by the WAOS.

Recommendations: Although the frequency of adverse perinatal events decreased after implementaton of the safety initiative, the overall severity of adverse events increased potentially reflecting the increased obstetrical patient acuity at the facility. The next study phase includes a retrospective quarterly review of AOI, WAOS, and SI scores during the implementation phase of the initiative to determine which specific components of the safety initiative made an impact. The SAQ, AOI, WAOS, and SI indicators will be used to evaluate team-based multidisciplinary obstetric simulation.


Presented at the 30th Annual International Nursing and Midwifery Research & Education Conference in Dubin, Ireland, on February 24, 2011.

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