Obstetricians Take Big Steps to Avoid Malpractice
Medical journal's report shows how breakthrough obstetrics reforms tied to NY Presbyterian/Weill Cornell hospital dramatically reduced staff errors and sliced medical malpractice payouts by more than 99%
By Gale Scott
crain's new york business.com
Published: March 4, 2011 - 3:27 pm
Delivering babies can be a high-stakes undertaking for hospitals, with the threat of multi-million-dollar malpractice damages when serious mishaps occur. But a team of Manhattan obstetricians says it has beaten the odds-dramatically reducing errors and slashing their department's medical malpractice payouts by more than 99%.
"Any hospital could do it-it's not about money, it's about changing the culture to make it safer to deliver babies," said Dr. Amos Grunebaum, who led his obstetrics team at New York Presbyterian Hospital/Weill Cornell in starting a comprehensive obstetrics safety program.
The new measures reduced errors and helped ward off unwarranted suits by clearly documenting everything doctors did right in cases where a bad outcome was not their fault, he said. And according to Dr. Grunebaum's report in the February issue of the American Journal of Obstetrics & Gynecology, these safety initiatives reduced so-called "sentinel events"-such as avoidable deaths and serious injuries-to zero in 2008-09, down from five in 2000.
Consumer advocates are hailing the report as a breakthrough in patient safety and a better way to curb malpractice costs than tort reform. "People don't get sued if they don't get hurt," said Blaire Horner, legislative director for the New York Public Interest Research Group (NYPIRG), a non-partisan research and advocacy organization. Mr. Horner added that he hopes the state's Department of Health will "sit down with the hospitals and make sure they've read it."
The article touched off heated debate in Albany, where the Medical Society of the State of New York, the New York chapter of the American College of Obstetricians and Gynecologists and the Greater New York Hospital Association are pushing for a bill that would put a cap of $250,000 on pain-and-suffering damages in medical malpractice awards. Those groups say such a limit would reduce both Medicaid costs and expenses for hospitals in general. Trial lawyers and consumer advocates have long opposed caps.
At NYACOG, Executive Director Donna Montalto said the Weill Cornell study has not changed her group's position: "We are all for obstetric safety but safety is not tort reform. We need reform now."
At Weill Cornell, the safety changes resulted in annual medical malpractice payouts dropping from an average of a $28 million from 2003 to 2006 to $2.6 million a year from 2007 to 2009. With no sentinel events reported in 2008 and 2009, those totals are expected to drop still further.
According to the medical journal article by Dr. Grunebaum and colleagues, the changes ranged from adding staff, updating equipment and instituting rigorous new protocols for patient care. For instance, he said, the use of several drugs often used in labor has been stopped or limited. Obstetricians at his hospital now rarely use oxytocin, a drug that speeds up labor. "This is a drug that causes fetal distress," he said.
Among the easier changes was doing away with the labor and delivery unit's dry-erase whiteboard, which staff used to communicate patients' progress. "We were using a 20,000-year-old technology here, something a caveman would have used," said Dr. Grunebaum.
Instead, the team came up with a new electronic application to do the same job better, a record that can be accessed through any Internet browser. No paper charting is allowed, both for improved communication and with an eye to leaving a clear legal record in case of a poor medical outcome.
Some of the staffing changes cost money. The unit hired a full-time patient safety nurse to educate staff on new protocols the doctors wanted and to conduct emergency drills, such as what to do when a mother started to hemorrhage, a life-threatening development.
Reasoning that doctors tend to make mistakes when they are deprived of sleep, the department hired three physician assistants and a "laborist," which is a new term for an obstetrician who works for a hospital full-time, instead of just having admitting privileges there. At Weill Cornell, the laborist works nights and weekends, reducing the time other obstetricians need to be "on call" in their off hours.
Though many aspects of the plan were costly, the authors concluded that the savings in medical malpractice payments "dwarf the incremental cost of the patient safety program."
Article can be found at http://www.crainsnewyork.com/article/20110304/FREE/110309912
