Comprehensive perinatal safety initiative to reduce adverse obstetric events.

Brian Wagner, Natalie Meirowitz, Jalpa Shah, Deepak Nanda, Lori Reggio, Phyllis Cohen, Karen Britt, Leah Kaufman, Rajni Walia, Corinne Bacote, Martin L. Lesser, Renee Pekmezaris, Adiel Fleischer, Kenneth J. Abrams

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.

Original languageEnglish
Pages (from-to)6-15
Number of pages10
JournalUnknown Journal
Issue number1
StatePublished - 2012
Externally publishedYes


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