HCA Has Achieved Dramatic Cost and Claims Reductions

In the February 2011 issue of the American Journal of Obstetrics & Gynecology (AJOG), "Patient safety in obstetrics–the Hospital Corporation of America experience." Dr. Steven Clark and his colleagues tell a great story about the continued success at HCA in reducing obstetric malpractice claims, highlighting especially their success defending shoulder dystocia cases.

Dr. Clark provides an update on the success of HCA’s program goals to improve perinatal outcomes and reduce litigation associated with obstetric care throughout the system. He reemphasizes the main themes from his 2008 paper, "Improved outcomes, fewer cesarean deliveries, an reduced litigation: results of a new paradigm in patient safety, including the need for process standardization, peer review, and empowering every clinical care team member to stop any process deemed unsafe and safeguard the patient against harm" (see figure 3.1 on the previous page). A major component in HCA’s program for improving the capability of their clinical staff involved the use of online education. In their recent article, Dr. Clark and his colleagues outline several expanded components of the program, listing the APS online curriculum at the top of the list, citing courses on Electronic Fetal Monitoring, Operative Vaginal Delivery, Managing Shoulder Dystocia, and Postpartum Hemorrhage. He goes on to mention the widespread adoption of the courses outside of HCA and premium incentives from insurers, negotiated by APS, for clinicians who satisfactorily complete courses.

In the paper, Dr. Clark notes that obstetric claims in the United States have increased by 15% since 2004, and the national average number of claims per 10,000 births remains 20% higher than HCA’s experience over the past three years. Dr. Clark states that "we are absolutely confident that adoption of our approach on a national level could, within 5 years, both dramatically reduce adverse perinatal outcomes and to a large extent eliminate the current national obstetric malpractice crisis."

Clark SL et al. Patient safety in obstetrics―the Hospital Corporation of America experience. Am J Obstet Gynecol. 2011 Apr;204(4):283.e1–7.

[top]

Purchase Continuing Education Credits

Individual or Volume licenses available

eLearning:

Bulletin

Lompoc Valley Medical Center

At the Lompoc Valley Medical Center (LVMC) in California, all physicians and nurses working in LVMC’s labor and delivery department completed the APS Perinatal Safety Curriculum. According to Lotta Andersson, Director of Perinatal Services and a practicing nurse midwife in her native Sweden for more than 30 years, the APS education program was uniformly well-received: "Everybody thought the courses were excellent. It was a lot of material, but once I sat down at the computer, I found it so interesting that I wanted to continue."

Ms. Andersson believes the courses are useful to clinicians at every phase of their careers—particularly those courses that addressed the use of standardized language developed by the National Institute of Child Health and Human Development. "Prior to the classes, you could have five experienced nurses describe a strip in different ways - but all mean the same thing. Now we feel very safe and secure, because we're all speaking the same language."

The educational program at LVMC was part of a comprehensive patient safety initiative offered by LVMC’s malpractice carrier, BETA Healthcare Group (BHG). "[With eLearning,] active participation is necessary, as individual competency can be assessed at every point…. There’s an assurance of guaranteed take-home learning that can be customized to each particular user," said Annie Herlik, RN, JD, CPHRM, Vice President of Risk Management at BHG. Participation in online patient safety courses is an increasingly important element in patient safety training from the standpoint of risk reduction, according to Ms. Herlik: "APS’s quality of content, use of graphics, and interactive learning design is the gold standard, and our feedback from clinicians has been overwhelmingly positive. Our biggest task is making sure hospitals and clinicians are aware of their access to the APS courses, because after that [the courses] really sell themselves."

Project Review: