Readmission reduction as an improvement measure has been found to be problematic as a maternal safety outcome. This statement shares concerns regarding incentivizing hospitalization reductions after birth and explores the potential for patient harm due to pressures to reduce readmissions when needed.

Adverse events in obstetrics put both maternal and infant patients at risk. The first commentary in this series describes strategies to identify and classify events in obstetric care. The second article discusses how to respond to adverse events, such as root cause analysis, error disclosure, and peer support.

Obstetric hospital admission has substantial potential for harm should something go wrong. Summarizing the unique characteristics of obstetric care that affect quality and safety, this commentary highlights strategies to improve safety in this setting, including Plan-Do-Study-Act cycles, simulation training, and crew resource management.

A comprehensive obstetric patient safety program at an academic hospital—which involved teamwork training, standardizing care protocols, and establishing a robust quality assurance mechanism (including a dedicated patient safety nurse and an anonymous error reporting system)—has previously been shown to decrease adverse events and improve safety culture. This follow-up study demonstrates that the program was also associated with a reduction in malpractice claims and total payments over a 5-year period. The relationship between patient safety and malpractice claims is complex, as claims data likely do not correlate with overall safety. However, the results of this study, along with other studies showing that full disclosure of adverse events can reduce malpractice claims, lends support to the belief that improving safety culture can have downstream effects on malpractice lawsuits at the health-system level.

A multifaceted patient safety program resulted in a sustained improvement in safety culture in an academic obstetrics unit. The program had previously been shown to reduce the incidence of preventable adverse events.

This brief commentary discusses the relationship between blame, accountability, and just culture, as well as support for clinicians involved in errors.

A multifaceted approach to patient safety resulted in improvements in both patient- and provider-related outcomes over a 3-year time frame. The strategy was developed after consultation with obstetric safety experts and included teamwork training, standardization of care protocols, and establishment of a robust quality assurance mechanism (including a dedicated patient safety nurse). Progressive implementation of the safety interventions was associated with a steady reduction in maternal and fetal adverse events, as well as improvement in the overall perception of safety culture (as measured by the Safety Attitudes Questionnaire). Prior research has demonstrated the effectiveness of crew resource management training in improving obstetric safety.