Tips for Reducing Medical Malpractice Claims in Obstetrics
The Doctors Company’s Obstetrics Closed Claims Study, a review of 882 obstetrical claims that closed from 2007-2014, revealed underlying vulnerabilities that place patients at risk and increase liability for doctors. Obstetricians have the unique risk of caring for two patients at the same time. Mothers and neonates have separate needs and can suffer different injuries.
The most common patient allegation against obstetricians, occurring in 22 percent of claims, was delay in treatment of fetal distress, including failure to act when presented with Category II or III fetal heart rate (FHR) tracings predictive of metabolic acidemia. The study also analyzed the specific factors that contributed to patient injury, and the second-most common factor in these claims (32 percent) was patient assessment issues, including misinterpretation of FHR strips and diagnostic test results.
The following tips to help physicians address these risks have been reviewed by Susan Mann, MD, a board-certified obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
These tips can help address FHR risks:
- Require periodic training and certification for physicians and nurses to maintain competency and facilitate conversations about FHR tracing interpretations. In addition, both parties should use the same terminology when describing the strips.
- Use technology that allows physicians to review FHR patterns from remote locations so that physicians and nurses are able to see the same information when discussing the next steps in labor and delivery care.
- Physicians who choose to attempt operative vaginal deliveries when faced with Category III FHR tracings indicative of metabolic acidemia should activate the contingency team to be available for an emergency C-section delivery in case the operative delivery fails.
- Foster a safe culture so that caregivers feel comfortable speaking up if they perceive a safety concern. Ensure that the organization has a well-defined escalation guideline.
Here are other steps obstetric professionals can take to reduce the risks identified in this study:
- Use prompts or checklists to help document thorough assessments, rationale for recommended care, information shared with patients/families, care provided, and outcomes of care.
- Review and evaluate your tracking systems for lab tests and referrals.
- Consider multidisciplinary simulation drills for metabolic acidemia, maternal hemorrhage, respiratory arrest in mother or newborn, shoulder dystocia, placental abruptions, amniotic fluid embolism, ruptured uterus, use of forceps and vacuum extraction, and meconium aspiration.
- Establish a contingency team of anesthesia coverage, surgical assistant availability, and OR team readiness to ensure you have the ability to perform stat cesarean deliveries when indicated, and perform readiness drills to test the team.
- Adopt IHI (or equivalent) vacuum bundle protocols. Create a protocol for newborns after vacuum delivery.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.