Patient safety in obstetrics and gynecology: an agenda for the future.

The effect of medical errors and unsafe systems of care has had a profound effect on the practice of obstetrics and gynecology. From 1975 to 2000, medical malpractice costs for obstetrician-gynecologists have risen nearly four-fold higher than that of other medical costs. In addition, it has been estimated that defensive medicine may cost society $80 billion per year. Most importantly, many obstetrician-gynecologists are frustrated and seem to be abandoning the parts of their practice they perceive to put them at higher liability risk. This article discusses other medical specialty society efforts that have been successful in addressing the area of patient safety. Efforts to better track quality outcomes has been initiated by the American College of Surgeons through the National Surgical Quality Improvement Project, and the American Society of Anesthesiologists has demonstrated both dramatically improved outcomes and reduced liability costs through a concerted patient safety effort. The author proposes changes in four areas to specifically address patient safety in obstetrics and gynecology, including: the development of reliable and reproducible quality control measures (and a system to track them); national closed claim reviews to better understand and address the most important safety and liability areas for obstetrician-gynecologists; work prospectively with pharmaceutical and surgical device manufacturers to develop innovative new products that would increase the likelihood of safe outcomes; and create a culture of safety in obstetrics and gynecology by incorporating safety education into all levels of training.