A new report from Hospitals Insurance Company (HIC) shows a 42 percent drop in the number of complications during labor and delivery among member institutions. The findings were remarkable, given that close to 15 percent of all deliveries in New York State occur in HIC member hospitals.
The sharp decrease comes as a result of a multiyear obstetric safety initiative in which four New York City hospitals joined forces to develop best practices for obstetrics. Working in collaboration, the hospitals reinforced the initiative through extensive training, robust auditing and documentation, and strict enforcement.
“Improving patient safety was our goal, and collaboration was the key to success,” said HIC President and CEO Lisa Kramer. “Hospital leadership demonstrated a strong commitment early on, ensuring a productive and successful relationship among the obstetric practice leaders and HIC.”
The Obstetric Quality Improvement Committee was established in 2006 under the guidance of obstetrics and gynecology department chairs from Maimonides Medical Center, Montefiore Medical Center, Mount Sinai Hospital, and Mount Sinai Beth Israel. The committee developed a set of best practices that was disseminated to participating hospitals in November 2007. The guidelines address critical patient safety and quality issues and are based on the best available evidence.
After circulating the best practices, the leadership team then established standardized education and training for relevant staff at each hospital. Mandatory electronic fetal monitoring training began in the spring of 2009, followed by advanced team training beginning in April 2010.
To help ensure full compliance, an extensive monitoring system was put in place, with ongoing auditing and personalized feedback for each practitioner. The HIC research staff now constructs an extensive clinical and process-of-care database each quarter, using a variety of electronic medical records designed to improve documentation and clinical care.
The multifaceted approach is working. A recent sample of 19,189 deliveries from participating hospitals from January 2008 through December 2011 showed a 42 percent decrease in the Adverse Outcome Index (AOI) (from 10.7 percent to 6.2 percent). In addition, the Weighted Adverse Outcome Score (WAOS) also decreased, from 3.9 to 2.3. The AOI is defined as the number of deliveries affected by one or more of 10 adverse outcomes, divided by the total number of deliveries. The WAOS is a similar measure that takes into account the severity of injuries.
“The success of this initiative shows that hospitals can pool resources to enhance safety,” said Dena Goffman, MD, Director of Maternal Safety and Simulation at Montefiore Medical Center and lead author of the report. “Facilitating best practices by developing relationships among institutions should be a wave of the future.”
Given the proportion of New Yorkers served by HIC member hospitals, the collaborative has the potential to serve as a proving ground for a wide variety of patient safety initiatives. In addition to approximately 15 percent of deliveries, HIC hospitals also account for 12 percent of all hospital beds, 12 percent of inpatient days, 13 percent of emergency department visits, and 12 percent of ambulatory visits statewide.
“One of the unique aspects of our work is the partnership between health care providers and professional liability insurers. We are fundamentally changing the dynamic and demonstrating how both groups can work toward the shared goals of improving patient safety and reducing adverse outcomes,” said HIC Chief Medical Officer David Feldman, MD.
The obstetric safety initiative grew from a partnership established in the mid-1970s when four large New York hospitals created a shared professional liability program, HIC, with their own risk management advisors, FOJP Service Corporation. The central mission of HIC and FOJP—unlike those of most private insurers—is to improve patient safety and quality of care within member hospitals. HIC does not have traditional shareholders and is not driven to recruit members or build profit margins. Instead, HIC and FOJP focus resources to reduce patient injury and improve clinical outcomes, even with the understanding that any impact on claim costs will not be observed or measurable for years to come.