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Am J Perinatol 2012; 29(01): 01-02
DOI: 10.1055/s-0031-1301056
Preface
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Safety during Perinatal and Neonatal Care: Research, Education, and Clinical Care Issues

Tonse N. K. Raju
1   Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Jennifer Bailit
2   Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western University, Cleveland, Ohio
› Author Affiliations
Further Information

Publication History

Publication Date:
23 January 2012 (online)

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Since the publication of the IOM report[1] patient safety issues have received more attention from the scientific community and the regulatory agencies. However, case series and observational studies continue to report adverse events from medical errors in obstetric, perinatal, and neonatal care. Despite quality of care and patient safety having been deemed “Hot Topics,” especially by the popular media, this topic is not a regular component of obstetric or pediatric education. There are still major gaps in research on quality and safety in perinatal and neonatal care.

To address these issues and to propose a research agenda, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) invited a panel of experts to a workshop in August 2010. The invited panel discussed generic aspects related to patient safety in the context of patient care, and specific aspects related to the perinatal patient safety issues. The summary of the proceedings from this workshop has been published.[2] The major conclusions from the workshop were that focused research needs to be undertaken to address both generic and systemic issues related to the environment that might lead to medical errors and patient harm, as well as address specific issues in the context of perinatal and neonatal patient care. Above all, the workshop panel stressed the need for inculcating a “culture of patient safety” at all levels of patient care, irrespective of whether the mission of a healthcare organization is medical education or research.

For this special issue of the American Journal of Perinatology we invited several experts to contribute topics related to patient safety in the context of perinatal-neonatal care. We trust that these papers may help to turn the charge to improve quality and safety into practical points for making that change happen in the perinatal setting.

Grobman’s article introduces the topic by defining the problems and going over the basic definitions of safety versus quality. He points out the multifactorial nature of the safety issues in perinatal medicine and the need to look at communication issues as a prime factor in preventable poor outcomes. Gregory and colleagues help us to understand how maternal and neonatal safety need to be balanced with each other to maximize outcomes. They provide a framework from which informed discussions can arise. Dr. Suresh describes the concepts and principles of measuring patient safety events such as medical errors and adverse events, and discusses the purposes and challenges of developing good measurement systems for patient safety and summarizes the literature on the methods that have been used to measure and monitor patient safety events. Menard and Chescheir review the indications for delivery at gestations earlier than 39 weeks, and discuss what medical conditions meet criteria for such deliveries. Their paper strongly endorses the position of the ACOG that deliveries prior to 39 weeks should be done when the health of the mother or baby are at stake. Kaplan and Ballard review how to improve quality and change practice patterns when quality goals have been set. Their manuscript highlights the science of implementation and tools to establish a culture of safety.

One of the controversial topics is the role of fatigue and its influence on patient care. In this regard, Majekodunmi and Landrigan provide an in-depth appreciation as to how patient safety could be compromised by fatigued individuals. Their report calls for reexamination of the educational needs and the curriculum alongside patient safety issues in the context of perinatal-neonatal care.

Medication errors remain the most common category of patient care related errors in all of medicine, including neonatal practice. Dabliz and Levine discuss specifics of how to reduce medication errors in the neonatal intensive care setting. It is now generally accepted that hospital-acquired infections are in fact reducible, and even a single such episode is one too many. Suresh and Edwards provide the epidemiology and an overview on this topic, and describe some practical ways to preventing such infections. Drs. Donn and McDonnell review the all important issue of disclosure of errors, and appropriate methods how to deal with them. They also touch upon the medico-legal implications related to medical errors and their consequences.

While no single issue of any journal can comprehensively address all of the complex aspects of medical errors and their consequences in the broad topic of perinatal-neonatal medicine, we, the guest editors, believe that taken together these articles may provide a brief overview, if not a “do-it-yourself” handbook for improving quality of care in the perinatal setting. We hope that this issue will be a practical guide and an introduction for those in maternal-fetal medicine, obstetrics, and neonatology, as well for the hospital administrators involved in improving the quality of care and reducing errors in the perinatal-neonatal setting.

And a bit of good news: we wish to refer scientists interested in conducting research and exploring funding for such work to the three links[3–5] that have been announced by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. These announcements will remain active until September 2013.