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Patient Safety in Obstetrics and Obstetric Anesthesia

Medical error is a leading cause of morbidity and mortality in hospitalized patients in the United States. Much attention has been called to this epidemic by the groundbreaking publication, “To Err is Human,” published by the Institute of Medicine (IOM) in 1999. In this report, it was suggested that up to 98,000 people die each year owing to preventable complications. More recent data suggest that the number of medical error–related deaths in the United States far exceeds the mortality associated with automobile crashes (45,000). Owing to increasing awareness of the potential harm resulting from medical error, the medical community has been directing emphasis and attention to strategies to decrease medical errors and improve patient safety during the hospital stay. Obstetric anesthesiologists, obstetricians, and obstetric nurses have been particularly instrumental in promoting this patient safety initiative. The labor and delivery suite is an ideal environment from which to pioneer system-based initiatives to reduce avoidable harm to patients. The suite is unique in that it involves interactions between many different teams, coming from different perspectives taking care of multiple patients, each of which has 2 lives at risk (the parturient and the fetus). As labor and delivery are the most common causes for hospitalization, and cesarean delivery is the most common operation in the United States, exposure to potential medical error is a real possibility for the parturient and the fetus. The actual number of medical errors resulting in adverse outcomes on patients in labor and delivery is difficult to quantify. However, in 2012, Clark and colleagues conducted a prospective study on “near-miss” events on labor and