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Newburn M. Ockenden report shows need for proper investment in workforce planning. BMJ 2022; 377:o1119. [PMID: 35512811 DOI: 10.1136/bmj.o1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nowotny BM, Basnayake S, Lorenz K, Hall J, Ruddock S, Fennessy G, Cox E, Hodges R, Loh E, Wallace EM. Using medico-legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy. BJOG 2019; 126:1437-1444. [PMID: 31131503 DOI: 10.1111/1471-0528.15823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement. DESIGN Qualitative descriptive study. SETTING Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia. POPULATION All obstetric claims and incident notifications occurring within the date range were included for analysis. METHODS De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified. MAIN OUTCOME MEASURES Rate of claims and notifications, relative frequency of issues, a revised taxonomy. RESULTS A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented. CONCLUSIONS Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement. TWEETABLE ABSTRACT New taxonomy to target health improvement from maternity claims based on NHSLA Ten Years of Maternity Claims.
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Affiliation(s)
- B M Nowotny
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Vic., Australia
| | | | - K Lorenz
- Victorian Bar, Melbourne, Vic., Australia
| | - J Hall
- Maryborough District Health Service, Maryborough, Vic., Australia
| | - S Ruddock
- Monash Health, Clayton, Vic., Australia
| | - G Fennessy
- Victorian Managed Insurance Authority, Melbourne, Vic., Australia
| | - E Cox
- Victorian Managed Insurance Authority, Melbourne, Vic., Australia
| | - R Hodges
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Monash Health, Clayton, Vic., Australia
| | - E Loh
- St Vincent's Health Australia, East Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Vic., Australia
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Cross-Sudworth F, Knight M, Goodwin L, Kenyon S. Systematic exploration of local reviews of the care of maternal deaths in the UK and Ireland between 2012 and 2014: a case note review study. BMJ Open 2019; 9:e029552. [PMID: 31256038 PMCID: PMC6609053 DOI: 10.1136/bmjopen-2019-029552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Local reviews of the care of women who die in pregnancy and post-birth should be undertaken. We investigated the quantity and quality of hospital reviews. DESIGN Anonymised case notes review. PARTICIPANTS All 233 women in the UK and Ireland who died during or up to 6 weeks after pregnancy from any cause related to or aggravated by pregnancy or its management in 2012-2014. MAIN OUTCOME MEASURES The number of local reviews undertaken. Quality was assessed by the composition of the review panel, whether root causes were systematically assessed and actions detailed. RESULTS The care of 177/233 (76%) women who died was reviewed locally. The care of women who died in early pregnancy and after 28 days post-birth was less likely to be reviewed as was the care of women who died outside maternity services and who died from mental health-related causes. 140 local reviews were available for assessment. Multidisciplinary review was undertaken for 65% (91/140). External involvement in review occurred in 12% (17/140) and of the family in 14% (19/140). The root causes of deaths were systematically assessed according to national guidance in 13% (18/140). In 88% (123/140) actions were recommended to improve future care, with a timeline and person responsible identified in 55% (77/140). Audit to monitor implementation of changes was recommended in 14% (19/140). CONCLUSIONS This systematic assessment of local reviews of care demonstrated that not all hospitals undertake a review of care of women who die during or after pregnancy and in the majority quality is lacking. The care of these women should be reviewed using a standardised robust process including root cause analysis to maximise learning and undertaken by an appropriate multidisciplinary team who are given training, support and adequate time.
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Affiliation(s)
| | - Marian Knight
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Laura Goodwin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sara Kenyon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Nowotny BM, Loh E, Davies-Tuck M, Hodges R, Wallace EM. Using patient factors to predict obstetric complaints and litigation: A mixed methods approach to quality improvement. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518799020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Traditionally, managing patient complaints and medicolegal claims has been largely a reactive process. However, attention has recently turned to systematically learning from complaints and litigation to prevent recurrence. Within a high-volume maternity service, we explored whether developing predictive tools for patient complaints and litigation to support proactive management was feasible. Objectives To develop and assess two screening tools to predict the likelihood of (i) patient complaints and/or (ii) medicolegal claims arising from maternity care and to assess practitioner awareness of patient risk factors. Methods Births between 1 April 2011 and 30 April 2016 at a university hospital maternity service in Melbourne, Australia were considered. Univariate binary logistic regression was performed to identify the variables contributing to complaints and claims. Backwards-stepwise logistic regression was applied to develop each screening tool. Clinicians completed a survey to assess awareness of identified risk factors. Results In the study period, there were 41,443 births, 173 complaints and 19 claims. The complaints tool had only fair predictive capacity (receiver operating characteristic 0.72, p < 0.001) and the claims tool failed. Neither approach afforded sufficient discrimination to be useful in routine predictive modelling. One hundred and one practitioners completed the survey (response rate 15.7%). Practitioners were better at recognising risk factors for legal claims than for patient complaints. Conclusion Whilst new risk factors for patient complaints and medicolegal claims were identified, we were unable to develop a screening tool that was sufficiently discriminatory to be useful in routine predictive triaging. However, increasing practitioner awareness of key risk factors may afford opportunities to improve care quality.
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Affiliation(s)
- Benjamin M Nowotny
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Erwin Loh
- Department of Innovations, Patient Safety and Experience, Monash Health, Clayton, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Ryan Hodges
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Women's and Newborn Program, Monash Health, Clayton, Victoria, Australia
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
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McNamara K, Meaney S, O'Connell O, McCarthy M, Greene RA, O'Donoghue K. Healthcare professionals' response to intrapartum death: a cross-sectional study. Arch Gynecol Obstet 2017; 295:845-852. [PMID: 28210863 DOI: 10.1007/s00404-017-4309-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/27/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exposure to adverse perinatal events can impact on the way healthcare professionals (HCPs) provide patient care. The aim of this study was to document the experiences of HCPs following exposure to intrapartum death (IPD), to identify opinions surrounding education and suitable support strategies, and to ascertain if involvement with an IPD had any impact on clinical practice. METHODS A questionnaire study, with open and closed questions, was developed and set in a tertiary maternity hospital. Consultant obstetricians, trainee obstetricians and midwives were invited to participate. Respondents were questioned about the impact that an intrapartum death had on them, the support they received in the immediate aftermath and their opinions regarding ongoing education and training in the areas of intrapartum death and self-care. RESULTS Eighty percent of HCPs in our study had a direct involvement with an IPD. Most (82%) HCPs received no training in dealing with IPD while 94% had no education on self-care strategies. Despite it being desired by most (80%), debriefing was offered to just 11% of HCPs who were involved in an IPD. Three main qualitative themes emerged from the data; the personal impact of IPDs on HCPs, implications for professional practice and future patient care, and the importance on non-judgemental support. CONCLUSION Maternity hospitals need to improve their support structures for HCPs following an IPD. It is hoped that this study will inform future educational practice and identify potential support strategies.
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Affiliation(s)
- Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.
| | - S Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - O O'Connell
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- Cork University Maternity Hospital, Cork, Ireland
| | - M McCarthy
- Cork University Maternity Hospital, Cork, Ireland
| | - R A Greene
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - K O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
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