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The Doctors Company conducted a study of claims and lawsuits involving neonatal injuries occurring in labor and delivery (L&D). Of the 247 neonatal injury claims that closed from 2007 through 2011, 36 percent (89 claims) included an allegation of delay in treatment of fetal distress. (Although the term “fetal distress” is vague and no longer recommended, the allegation of delay in treatment remains an important concept in understanding these claims and lawsuits.)
The claims review revealed the following:*
*Please note that more than one category applied in some of these cases.
Be proactive to ensure preparedness.
Communicate in real time.
Prepare for second-stage complications.
|–||Consider alternative labor strategies.|
|–||Prepare the patient by discussing the risks, documenting consent, and ensuring physical preparedness (empty bladder).|
|–||Estimate the fetal weight (EFW), determine the fetal position and the station for high success probability, and document this information.|
|–||Predetermine maximum application time and number of pop-offs.|
|–||Plan an exit strategy (cesarean section in less than 30 minutes), and confirm that the components are available. Have the resuscitation team available.|
Addressing these themes proactively and in real time should become a strategic activity for physicians and nurses who staff obstetrics departments. Increased readiness for and recognition and management of complications, improved communications, and required technical skills should all work in concert to reduce the likelihood of these difficult and tragic outcomes.
1. Peter Cherouny, MD, “Vacuum Delivery Bundle” (lecture, IHI Perinatal Community: IHI Collaborative, 2007).
2. Michael Ross, MD, “Vacuum Delivery: What Can Go Wrong” (lecture, 27th Annual Conference on Obstetrics, Gynecology, Perinatal Medicine, Neonatology, and the Law, Boston University, January 2011).
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 considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.