Sinni Suzanne V, Cross Wendy M, Swanson Amy E, Wallace Euan M
Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
Monash Women's Services, Monash Health, Clayton, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2016 Apr;56(2):142-7. doi: 10.1111/ajo.12441. Epub 2016 Feb 3.
Obstetrics remains the largest medico-legal liability in healthcare. Neither an increasing awareness of patient safety nor a long tradition of reporting obstetric outcomes have reduced either rates of medical error or obstetric litigation. International debate continues about the best approaches to measuring and improving patient safety. In this study, we set out to assess the feasibility and utility of measuring the process of maternity care provision rather than care outcomes.
To report the development, application and results of a tool designed to measure the process of maternity care.
A dedicated audit tool was developed, informed by local, national and international standards guiding best practice and then applied to a convenience sample of individual healthcare records as proof of function. Omissions of care were rated in order of severity (low, medium or high) based on the likelihood of serious consequences on patient safety and outcome.
The rate of high severity omissions of care was less that 2%. However, overall rates of all omissions varied from 0 to 99%, highlighting key areas for clinical practice improvement.
Measuring process of care provision, rather than pregnancy outcomes, is feasible and insightful, effectively identifying gaps in care provision and affording opportunities for targeted care improvement. This approach to improving patient safety, and potentially reducing litigation burden, promises to be a useful adjunct to the measurement of outcomes.
在医疗保健领域，产科仍然是最大的医疗法律责任领域。无论是对患者安全意识的提高，还是长期以来报告产科结局的传统，都未能降低医疗差错率或产科诉讼率。关于衡量和提高患者安全的最佳方法的国际辩论仍在继续。在本研究中，我们着手评估衡量产科护理过程而非护理结局的可行性和实用性。
报告一种旨在衡量产科护理过程的工具的开发、应用及结果。
在指导最佳实践的地方、国家和国际标准的基础上，开发了一种专门的审计工具，然后将其应用于个体医疗保健记录的便利样本，以证明其功能。根据对患者安全和结局产生严重后果的可能性，将护理遗漏按严重程度（低、中或高）进行评级。
严重护理遗漏率低于2%。然而，所有遗漏的总体发生率从0%到99%不等，突出了临床实践改进的关键领域。
衡量护理过程而非妊娠结局是可行且有洞察力的，能有效识别护理提供中的差距，并为有针对性的护理改进提供机会。这种提高患者安全并可能减轻诉讼负担的方法有望成为结局测量的有益补充。
