Boston, MA - January 9, 2019
- Coverys, a leading provider of medical professional liability insurance, today released its latest Dose of Insight
report, providing a data-driven look at the state of obstetrical care in the United States. The report analyzes more than 470 obstetric-related closed medical professional liability claims at Coverys across a five-year period (2013-2017) to identify areas of vulnerability during the maternal/fetal episode of care – from early pregnancy management to labor and delivery.
“Delivering obstetrical care requires continuous attention, as every patient and every pregnancy present unique issues, challenges, and opportunities,” said Marlene Icenhower, senior risk consultant at Coverys and co-author of the report. “Managing such risks is far from simple, but we can learn from past obstetrics claims to implement new processes, practices, and systems, and ultimately help improve patient safety.”
Key findings from the report include:
- The top allegation in obstetrical claims is negligence during the management of labor – accounting for 40% of claims.
- Vaginal births resulted in more claims than cesarean sections (52% vs. 45%) and more than 3 times as many claims as emergency cesarean sections (52% vs. 15%).
- 80% of OB claims involve injuries with the highest clinical severity – such as maternal loss of fertility, cerebral palsy, neonatal blindness, or hearing impairment – and 24% resulted in death of the infant, mother, or both.
- Clinical judgment was the top risk management issue, cited in over 50% of claims and reflected in all phases of the perinatal process.
- 58% of OB-related claims involved patients with at least one known risk factor (or comorbidity), such as diabetes, obesity, and hypertension.
Adverse events may be reduced by taking a close look at the data about maternal/fetal risk and then making changes to improve outcomes and reduce liability. In the report, the authors share risk management recommendations relative to pregnancy, including setting expectations with the patient on what is normal or abnormal, documenting patient concerns using their own words, and referring patients with high-risk factors to specialists if necessary.
- Risk management recommendations relative to labor include developing evidence-based fetal monitoring policies and a formal chain of command policy for providers and staff in the obstetrics department.
- Relative to delivery, the authors recommend practicing effective and persuasive communication during challenging circumstances and ensuring policies, procedures, and/or protocols regarding emergency cesarean sections and for documenting the evaluation of fetal status are consistent with ACOG recommendations.
“If an adverse event occurs in the practice of obstetrics, the results are often permanent, significant, grave, or even fatal. Our data underscores just how important it is that providers and healthcare organizations explore ways to proactively mitigate adverse events,” said Maryann Small, MBA, director of data governance & business analytics at Coverys and co-author of the report. “We hope that our claims data educates providers on potential risks and motivates change as we collectively rise to the challenge of continually improving care for mothers and babies.”
This is the third report in Coverys’ Dose of Insight series, which has previously explored medication error
and diagnostic accuracy
. The report, co-authored by Maryann Small, director of data governance & business analytics; Robert Hanscom, VP of business analytics; Kim Hoppe, senior risk specialist; and Marlene Icenhower, senior risk consultant, is available for download on the Coverys website here