Chapter 41: Patient Safety and Quality Assurance in Obstetrics

WHY SHOULD PHYSICIANS CARE ABOUT PATIENT SAFETY AND HEALTH CARE QUALITY?

Patient safety is a global concern and landmark publications and reports have highlighted the extent of concerns present in health care systems. The Institute of Medicine (IOM) released the ground-breaking report “To Err is Human: Building a Safer Health System,” which estimates that between 44,000 and 98,000 hospital deaths per year are due to medical error. The Canadian Adverse Events Study reported a 7.5 percent incidence rate of adverse events in Canadian hospitals. Among the adverse events reported, 36.9 percent were judged to be preventable and 20.8 percent resulted in a patient death. It is estimated that one in 10 patients in high-income countries are harmed while receiving care in a hospital setting. Patient safety incidents also represent a significant financial burden on the health care system across the world.

Health care providers and institutions must make an ongoing commitment to patient safety by shifting the culture to focus on patient safety and incorporating patient safety education at all levels of medical training. The creation and implementation of reliable patient safety incident reporting systems should reduce patient safety incidents, provide learning opportunities for the health care team, and improve the quality of patient care in a sustainable fashion.

Definitions

Patient safety is defined as the freedom from potential or unnecessary harm for a patient related to the delivery of health care. Patient safety aims to reduce the risk of patient harm that occurs during health care provision and utilizes best practices demonstrated to lead to optimal patient outcome. The key component of patient safety is continuous improvement guided by learning from adverse events and errors.

The World Health Organization (WHO) Conceptual Framework for the International Classification for Patient Safety was developed to provide patient safety terminology that can be utilized globally.

Patient Safety Incident

An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. A patient safety incident (PSI) can be classified as a reportable circumstance, near miss, no harm incident, or harmful incident.

Reportable Circumstance

A situation in which there was significant potential for harm, but no incident occurred (e.g., a busy labor and delivery unit remaining grossly understaffed for an entire shift, or bringing a vacuum to an operative vaginal delivery only to discover it does not work although it was not needed).

Near Miss

An incident which did not reach the patient (e.g., an antibiotic being connected to the wrong patient’s intravenous line, but the error was detected prior to starting the infusion).

No Harm Incident

An event reached a patient but no discernable harm resulted (e.g., an antibiotic was infused into a patient’s intravenous ...