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Reducing adverse obstetrical outcomes through safety sciences

Christopher S Ennen, MD, CDR, MC, USN
Andrew J Satin, MD, FACOG
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


Patient safety is about minimizing error and preventing harm. Reasons for errors include human fallibility, medical complexity, system deficiencies, and defensive barriers. In 1999, the Institute of Medicine estimated that medical errors account for up to 98,000 deaths each year in the United States [1].

Although there are more than 4 million hospitalizations related to childbirth in the United States each year, there is a paucity of data specifically addressing medical errors in obstetrics. Nevertheless, medical errors do not spare this population and it is likely that strategies to reduce these errors would benefit pregnant women and their children.

Strategies to reduce errors and subsequent adverse outcomes have focused on team and individual training; simulations and drills; development of protocols, guidelines and checklists; use of information technology; and education [1]. These activities and tools apply to inpatient and office settings [2]. Although most studies describe positive reactions among participants and improvements in knowledge, skills, and behavior, data on patient outcomes after clinician-training programs are limited [3]. Simulation training, specifically as it relates to shoulder dystocia management and performance of operative vaginal delivery, has shown the most promise for improving clinical outcomes.


Failures in teamwork and communication account for 70 percent of sentinel events in obstetrics [4]. Recognizing this, the Joint Commission, the American College of Obstetricians and Gynecologists (ACOG), and the Institute of Medicine all acknowledge that teamwork/communication is a critical element of patient safety [1,4,5].

In a labor and delivery setting, the patient and her baby are not cared for solely by her obstetric providers, but also by nurses, anesthesia and pediatric providers, and support staff. Formal teamwork training is increasingly becoming a part of the orientation of new hospital staff members, with the goal of improving teamwork and communication [6,7]. There is some evidence (reviewed below) that formal training in these concepts will improve patient safety, team performance, and maternal-fetal outcomes.

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Literature review current through: Nov 2017. | This topic last updated: Aug 21, 2017.
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