Obstetricians told to talk, write more clearly

Obstetricians were told on Monday that they could improve patient safety and combat soaring rates for malpractice insurance by stressing simple teamwork, better communication with nurses and by writing more clearly.

By making those and related reforms, U.S. hospitals and doctors would be drawing on the best safety practices of the airline industry and the military in a bid to make the process of childbirth less risky, experts said on Monday.

"We are trying to get people to think in terms of systems, not individuals," Dr. Lucian Leape, an adjunct professor of health policy at Harvard School of Public Health in Boston, said at a meeting today of the American College of Obstetricians and Gynecologists.

Doctors at the conference stressed simple measures such as clearer handwriting, better medical test tracking and more communication between nurses, doctors and other staff as ways to reduce medical errors.

"Most problems are not due to an individual, they are system problems," said Dr. Stanley Zinberg, the medical specialty group's vice president for practice activities.

A 1999 report from the Institute of Medicine estimated that 1 million people are injured annually by treatment errors at U.S. hospitals, with as many as 98,000 deaths caused by those errors.

"As the American health care system grows more complex, the potential for human error only compounds," Zinberg said.

Yet improving communication in the traditionally hierarchical medical setting is easier said than done. "It is very countercultural to the way we were taught," Leape said. "And hanging over all of this is the specter of malpractice."

He has called for a system of no-fault medical liability insurance, which would offer limited compensation to anyone injured by medical error.

Dr. Benjamin Sachs, chief obstetrician-gynecologist at Beth Israel Deaconess Medical Center in Boston, is leading a study, funded by the U.S. Department of Defense, to test whether 15 hospitals can improve childbirth safety with techniques used by commercial airlines and the military.

The standards were developed after the National Aeronautics and Safety Administration found that human error and failures of communication were involved in a majority of accidents. Emphasis is put on teamwork and communication as well as better information systems.

"Why should we be practicing medicine the way Marcus Welby did?" said Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services.

Leape, estimating the agency's annual budget at around $250 million, said the U.S. spends about 1 percent of what it spends on developing new health therapies "to assess whether they are making any difference."

The safety study led by Sachs is not yet complete, but he said the rate of "adverse outcomes" at his own hospital has fallen by more than half in the last four years. Over the same period, the doctors malpractice premiums have fallen 10 percent, Sachs said.