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Am J Obstet Gynecol. 2009 May;200(5):492.e1-8. doi: 10.1016/j.ajog.2009.01.022. Epub 2009 Feb 27.

Impact of a comprehensive patient safety strategy on obstetric adverse events.

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  • 1Department of Obstetrics, Gynecology, and Reproductive Science, Yale University School of Medicine, New Haven, CT 06520-8063, USA.



We implemented a comprehensive strategy to track and reduce adverse events.


We incrementally introduced multiple patient safety interventions from September 2004 through November 2006 at a university-based obstetrics service. This initiative included outside expert review, protocol standardization, the creation of a patient safety nurse position and patient safety committee, and training in team skills and fetal heart monitoring interpretation. We prospectively tracked 10 obstetrics-specific outcome. The Adverse Outcome Index, an expression of the number of deliveries with at least 1 of the 10 adverse outcomes per total deliveries, was analyzed for trend.


Our interventions significantly reduced the Adverse Outcome Index (linear regression, r(2) = 0.50; P = .01) (overall mean, 2.50%). Concurrent with these improvements, we saw clinically significant improvements in safety climate as measured by validated safety attitude surveys.


A systematic strategy to decrease obstetric adverse events can have a significant impact on patient safety.

[PubMed - indexed for MEDLINE]
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