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In 2003, malpractice insurer MCIC Vermont, which is owned by Johns Hopkins Medicine and several other academic medical centers, launched an obstetrical care initiative across 10 of its participating hospitals. This effort was designed to advance patient safety, decrease the risk of patient injury and reduce professional liability risk.
The next year, the insurer funded five hospital-based perinatal patient safety nurses to implement the OB initiative, including one for Hopkins Medicine. The major components of the initiative were:
- teamwork training—such as Veterans Health Administration, Med Teams and TeamStepps programs—for all members of the perinatal care team to improve the quality of collaboration and communication.
- use of consistent protocols for safe use of oxytocin for induction and augmentation of labor
- adoption of nationally recognized nomenclature for interpretation of all electronic fetal monitoring (National Institute of Child Health and Human Development nomenclature)
- required certification in electronic fetal monitoring for all obstetrical physicians, nurse midwives and nurses, by utilizing the National Certification Corporation examination
- use of high-fidelity simulators
- workgroups focused on chain of command, shoulder dystocia documentation and maternal injuries—issues associated with past patient safety incidents
The results were impressive: Over the course of the initiative, Johns Hopkins Health System hospitals experienced a 29 percent decrease in claim cost and a 28 percent decrease in claim frequency.