By | October 22, 2019

In any organization, risk management is necessary—however, risk management within the healthcare industry takes on a whole new meaning. For other industries, the focus is primarily centered around financial impact(s). While this is certainly a concern for hospitals and health systems, no other industry is driven by a focus on patient lives, in terms of patients dying or being harmed at the hands of the hospital or care team. This fact significantly raises the stakes for hospitals and health systems to ensure successful risk management is an ongoing focus for the organization.

The Root of Risk Management

Although obstetricians/gynecologists represent only 5% of U.S. physicians, they generate 15% of liability claims and 36% of total payments made by medical liability carriers, according to the American Society for Health Care Risk Management (ASHRM).

Additionally, a 2018 report produced annually by Aon/ASHRM, found that the severity of extreme professional liability claims is trending at a higher rate than typical self-insured claims. The ASHRM/Aon 2018-2019 Hospital and Physician Professional Liability Benchmark  Report findings include:

  • Labor and Delivery related issues, with an average value over $400,000, continue to be significantly more severe than claims related to other allegations.
  • Projected loss rate for obstetrics claims occurring in 2019 is $182 per birth and emergency department is $5.73 per visit.

The Centers for Disease Control and Prevention (CDC) shared data from a 2016 survey indicating 145.6 million emergency department visits. Couple that number with the reported 3.8 million babies born in 2017 and factor in their mothers as patients as well, and we have a sizeable patient population.

Not only are the stakes high in terms of volume of patients, but understanding the unique risk factors in the labor & delivery and emergency departments adds perspective on why organizations commonly find these departments to have the highest risk.

Obstetrics

Earlier this year, an article appearing in The New York Times again highlighted the ongoing issues related to death of women in the U.S. during their pregnancy and/or delivery of their babies. This comes months after the article that originally brought attention to maternal mortality rate (shared in USA Today last year). These articles draw attention to the national maternal mortality crisis, highlighting the alarming fact that the U.S. has the highest maternal death rate among the world’s developed nations, has continued to rise, while the death rate has been stable or falling in other developed countries (discussed in greater detail in this previous blog post).

Emergency Department

In this fast-paced environment, clinicians encounter waves of minor injuries to more serious, life-threatening cases and must be prepared for “whatever might come their way” and have the competency to treat a wide array of patients of all ages and possible conditions. Patients entering the emergency room from outside the hospitals or a previous care setting may be unconscious or in no condition to accurately communicate their symptoms, medical history, or drug allergies, setting an unsettling stage for potential increased risks. Additionally, a large source of malpractice claims are a result of failed or delayed diagnoses, improper assessment, and breakdown in communication.

3-Step Framework to Increase Patient Safety by Reducing Risk:

1. Analyze

data iconStart with good data so that you know just where to focus your energies. When available, real-time analytics is especially beneficial to understand which areas of training will have the greatest impact on quality of care, increase patient safety, and reduce the risk of adverse events.

2. Assess

check list on clipboardEvaluate the skills of every team member involved so that you can target problem areas and not waste providers’ valuable time. By gaining insight into competency levels for individuals and teams to identify areas that deserve targeted education, organizations can mitigate risk by increasing patient safety and reducing risk of OB and ED claims.

3. Educate

education iconGive everyone the tools they need to learn the skills they’re lacking and get better at their jobs. High reliability organizations (HROs) are true learning organizations and value the importance of providing healthcare workers with the most current, evidence-based education available, in a format that’s both easily accessible and easy to comprehend and retain.

What Success Looks Like: Addressing Risk within the ED and OB

BETA Healthcare Group (BETA) is the largest professional liability insurer of hospitals on the West Coast and provides coverage to more than 575 hospital and healthcare facility locations.

Starting in 2008, BETA allied its “Quest for Zero” initiative with Relias to provide its members and insureds the opportunity for significant reduction in premiums each policy year. The programs specifically focus on BETA’s two highest risk areas, obstetrics and the emergency department, and strive to reach zero preventable, unanticipated events resulting in patient harm.

As part of the initiative, BETA facilitated the implementation of Relias ED and Relias OB (formerly known as GNOSIS™) content. From 2008-2012, BETA experienced greater than a 50% reduction in claims occurring in obstetrics after working with Relias. Learn more about BETA’s impressive results in this success story.

How Relias Can Help

For more than 20 years, Relias has helped hospitals identify and reduce variation in care and improve patient safety with analytics, provider and nurse assessments, and evidence-based education tailored to the individual.

Relias OB offers a suite of AWHONN validated and co-authored courses for providers and nurses on promoting vaginal birth, fetal assessment and monitoring, shoulder dystocia, obstetrical hemorrhage, and hypertensive disorders in pregnancy.

Relias ED addresses high-risk areas through an ENA-approved comprehensive program focusing on: high-risk abdominal pain, high-risk chest pain, nursing triage, pediatric fever, sepsis for emergency RNs, and communication in the ED.

Lora Sparkman, MHA, BSN, RN

Lora Sparkman, MHA, BSN, RN, is a Clinical Effectiveness Consultant for Relias. She provides internal and external consulting, thought leadership, and strategic guidance on the use and optimization of Relias clinical solutions related to improving patient safety and creating high reliability in some of the highest risk areas in healthcare: Obstetrics and Emergency Department as well as other clinical areas with the acute care setting. Prior to Relias, Lora worked for Ascension as a Director of Clinical Excellence. In her role, she had the opportunity to work with clinical leaders and innovators from across the country in improving the delivery of care demonstrating results in patient outcomes and reducing the cost of risk. Lora is a registered nurse, holds a Master of Health Administration from Lindenwood University, a Bachelor of Science in Nursing from the University of Missouri, and a Diploma in Nursing from Barnes Hospital School of Nursing.

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