“There is a crisis of confidence in American healthcare right now,” said Funai. “Reports in the media about patient injury in the hospital setting were causing concern, and we sought to apply some basic principles to obstetric care to make it a great deal safer than it is right now.”

Funai and his team designed and implemented clinical patient safety interventions at Yale-New Haven Hospital. These included communication training, standardizing interpretation of fetal monitoring, and creating a novel staff role—the patient safety nurse. In tracking and analyzing 14 markers for adverse outcomes, the team found that the rate of adverse events decreased by about 60 percent over 2.5 years, while the staff’s own perception of the overall safety climate increased by 30 percent, according to a survey given by a third party.

Funai said that the main cause of adverse events and patient injury is a breakdown in communication, usually involving failure to recognize the severity of a given situation or condition, often involving a newborn’s status.

“Communication issues are only going to increase as a result of restrictions on resident work hours,” he said. “Patients are increasingly handed off from shift to shift and more attending physicians are practicing shift medicine. There is just more opportunity for errors in patient care. Everything we can do to standardize care and facilitate communication will make a big difference.”

Funai said, “After taking these surprisingly simple steps to address safety, both patients and staff report that the care is much more seamless and better organized,” he said. “The staff is more comfortable and empowered to communicate their concerns about a patient. A comfortable staff often leads to more successful patient outcomes.”

Other authors on the abstract included Christian M. Pettker, Stephen Thung, Jennifer Cheryl Raab, Errol Norwitz, Catalin Buhimschi, Joshua Copel and Charles Lockwood.

A discussion on this topic is available on Yale University iTunes U, “Health and Medicine” section.
http://deimos3.apple.com/WebObjects/Core.woa/Browse/yale.edu.1320598949