Top Drivers of Risk: Obstetrical Allegations

In this blog series, Lori Atkinson discusses the top drivers of risk and malpractice claims and explores strategies to mitigate risk and enhance patient safety.

I discussed the top malpractice allegations across all healthcare settings in my first two blogs of this series, Top Drivers of Risk: Surgical Allegations and Top Drivers of Risk: Diagnostic Errors.

In this blog, I'll discuss how simulation can reduce obstetrical (OB) adverse events and malpractice claims. At Curi, we analyze our malpractice claims to identify and examine the top allegations, helping clinicians and their organizations implement strategies to reduce adverse events and claims.

Obstetrical Claims

In the subset of Curi claims analyzed, obstetrical allegations are number three in cost despite representing only 4% of claims. The top allegations triggering our OB claims are:

• Delay in treatment of fetal distress: 44% of OB cost and 24% of claims. These claims resulted in permanent injury or death 89% of the time.
• Improper performance of vaginal delivery: 11% of OB cost and 18% of claims.
• Improper management of pregnancy: 10% of OB cost and 16% of claims.

The top factors contributing to our OB claims include:

• Improper selection/management of pregnancy/labor and delivery
• Patient assessment issues
• Communication breakdowns among the OB team and with patients
• Technical performance issues
• Documentation issues

How Simulation Training Can Reduce OB Adverse Events

Simulation-based training allows OB teams to practice managing serious and life-threatening situations in a controlled learning environment. By replicating real-life scenarios, OB clinicians and care teams can refine their skills and improve team communication without putting mothers and babies at risk.

Simulation can help by:

Enhancing clinical competency - Simulation training enables OB clinicians and teams to practice together in responding to high-risk, low-frequency events such as shoulder dystocia, obstetric hemorrhage, emergency cesarean delivery, and severe hypertension. Repeated exposure to these scenarios improves clinical skills, decision-making, and confidence.

Improving team communication - OB emergencies require coordination, communication, and teamwork. Simulation fosters role clarity, collaboration, and practice using communication tools.

Identifying and mitigating system errors - Organizations can detect system-generated inefficiencies through simulated scenarios, such as workflow bottlenecks, inadequate resources, or lack of emergency protocols. Addressing system issues identified by simulation proactively improves safety.

Boosting situational awareness - Simulation helps OB clinicians and care teams develop situational awareness by exposing them to realistic stressors and unanticipated developments, reinforcing their ability to make quick, informed decisions.

Promoting a culture of continuous improvement and learning - Regular simulation drills encourage a collaborative, interprofessional culture. By debriefing after each simulation training session, teams refine their approach and strategies to ensure best practices are used.

Risk Reduction Strategies

• Implement guidelines outlining how often simulation drills should be conducted and expectations regarding participation. Some organizations have made simulation training mandatory as a part of the medical staff credentialing process.
• Require all OB clinicians and Labor and Delivery teams to participate in simulation training. Simulation sessions should also include clinicians and team members who respond to a specified obstetric emergency (e.g., ED teams, pediatricians, NICU teams, anesthesiologists, and ancillary services like the blood bank or laboratory).
• Conduct a debriefing after every simulation drill to identify what went well and opportunities for improvement. Review the communication that happened during the simulation. Was it effective? Consider creating a debriefing form or checklist to facilitate and standardize the debriefing process.

Curi Resources

Curi clients, sign in to our Risk Solutions Resource Catalog to take our Obstetric Risk Assessment, watch the on-demand video Shoulder Dystocia Clinical Considerations & Risk Management Strategies, and download several of our OB-GYN Guidelines related to this topic:

• OB-GYN Guidelines: Obstetrical Emergency Drills and Simulations
• OB-GYN Guidelines: Shoulder Dystocia
• OB-GYN Guidelines: Category II Fetal Heart Rate Tracing Algorithm Guideline
• OB-GYN Guidelines: Second Stage of Labor Management

If you have questions about this topic, please call 800-328-5532 to speak with one of Curi Advisory's Risk Solutions Consultants.

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