OJOG  Vol.5 No.5 , May 2015
Obstetrics Risk Management in 5 Iranian Hospitals (Tehran-2012)
ABSTRACT

Background: Risk management is improving quality of health care services and creating a safer system of care. We determined the main maternal and fetal risks in five Hospitals (Tehran-Iran) to offer some practical strategies to decline obstetric adverse events and provide better pregnancy outcome. Methods: A descriptive, cross-sectional study was carried out in 5 Iranian hospitals (2011-2012). Twelve Obstetricians/perinatalogists and midwives from 5 hospitalswho were in charge of Maternity Units, were our assistants in these hospitals. We organized a secretariat including Obstetricians/perinatalogists and midwives. The principles of Obstetrics Risk Management were introduced to them in a 2 days’ workshop. Then the delegates from each hospital were asked to report the most common obstetrical complications of their hospitals. The main results were 24 complications. Then for sorting these risks we asked them to do scoring of the 24 complication with 1 - 10 grading in 4 aspects of probability of occurrence, possibility of prevention, priority of interventions and short term response to interventions. Post partum haemorrhage, labor management problems, and neonatal hypothermia got the highest scores in these regards, and then these 24 items were categorized in 2 groups of risk assessment and hospital management. Finally based on Risk Management Rules in Clinical Governance, the complications analysis was done with use of failure mode, effects analysis and practical strategies to decline obstetrical adverse events were suggested. Results: We understood all reported complications had common infrastructural problems: defects in Risk Assessment and Hospital Management Policies. We focused on basic infrastructural management in these 2 main subjects and in these two: our main problems were related to staff management and hospital management issues. Conclusion: Since managerial and staff dependent problems were our main problems, these two should be considered as our main priorities in risk management program.


Cite this paper
Changizi, N. , Babaee, F. , Ravaghi, H. and Farahani, Z. (2015) Obstetrics Risk Management in 5 Iranian Hospitals (Tehran-2012). Open Journal of Obstetrics and Gynecology, 5, 259-267. doi: 10.4236/ojog.2015.55038.
References
[1]   Specchia, M.L., Poscia, A., Volpe, M., Parente, P., Capizzi, S., Cambieri, A., et al. (2015) Does Clinical Governance Influence the Appropriateness of Hospital Stay? BMC Health Services Research, 15, 142.

[2]   Heidar Pour, P., Dastjerdi, R., Rafiei, S. and Mostofian, F. (2011) Clinical Governance Principles. Tandis, Tehran, 14.

[3]   World Health Organization (2009) WHO Patient Safety Curriculums Guide for Medical School.

[4]   Verbano, C. and Turra, F. (2010) A Human Factors and Reliability Approach to Clinical Risk Management: Evidence from Italian Cases. Safety Science, 48, 625-639.
http://dx.doi.org/10.1016/j.ssci.2010.01.014

[5]   Arulkumaran, S. (2010) Clinical Governance and Standards in UK Maternity Care to Improve Quality and Safety. Midwifery, 26, 485-487.
http://dx.doi.org/10.1016/j.midw.2010.08.002

[6]   Guise, J.M. (2008) Team Work in Obstetric Critical Care. Best Practice & Research Clinical Obstetrics and Gynaecology, 22, 937-951.
http://dx.doi.org/10.1016/j.bpobgyn.2008.06.010

[7]   Scholefield, H. (2005) Risk Management in Obstetrics. Current Obstetrics & Gynaecology, 15, 237-243.
http://dx.doi.org/10.1016/j.curobgyn.2005.05.007

[8]   Mac Kenzie, H.B. and Van Teijlingen, E. (2010) Risk, Theory, Social and Medical Models: Acritical Analysis of the Concept of Risk in Maternity Care. Midwifery, 26, 488-496.
http://dx.doi.org/10.1016/j.midw.2010.07.003

[9]   Cottee, C. and Harding, K. (2008) Risk Management in Obstetrics. Obstetrics, Gynaecology Reproductive Medicine, 18, 155-162.
http://dx.doi.org/10.1016/j.ogrm.2008.04.003

[10]   Scholefield, H. (2008) Safety in Obstetric Critical Care. Best Practice & Research Clinical Obstetrics and Gynaecology, 22, 965-982.
http://dx.doi.org/10.1016/j.bpobgyn.2008.06.009

[11]   WHO, UNICEF, UNFPA and The World Bank (2012) Trends in Maternal Mortality: 1990 to 2010. WHO, Geneva.

[12]   Health Ministry, DHS Survey (2012) Maternal Health Department, Family Health Bureau.

[13]   Almeida, M.F.B., Guinsburg, R., Sancho, G.A., Rosa, I.R., Lamy, Z.C., Martinez, F.E., et al. (2014) Hypothermia and Early Neonatal Mortality in Preterm Infants. The Journal of Pediatrics, 164, 271-275.
http://dx.doi.org/10.1016/j.jpeds.2013.09.049

[14]   Cheng, S. and Lew, E. (2014) Obstetric Haemorrhage: Can We Do Better? Trends in Anaesthesia and Critical Care, 4, 119-126.
http://dx.doi.org/10.1016/j.tacc.2014.04.007

[15]   Duncan, T. and McEwanb, A. (2004) An Evidence-Based Approach to the Management of Abnormal Labor. Current Obstetrics & Gynaecology, 14, 277-284.
http://dx.doi.org/10.1016/j.curobgyn.2004.04.009

[16]   Sultan, P., Arulkumaran, N. and Rhodes, A. (2013) Provision of Critical Care Services for the Obstetric Population. Best Practice & Research Clinical Obstetrics and Gynaecology, 27, 803-809.
http://dx.doi.org/10.1016/j.bpobgyn.2013.07.005

[17]   Guise, J.M. (2007) Anticipating and Responding to Obstetric Emergencies. Best Practice & Research Clinical Obstetrics & Gynaecology, 21, 625-638.
http://dx.doi.org/10.1016/j.bpobgyn.2007.02.004

[18]   Simpson, H. and Barker, D. (2008) Role of the Midwife and the Obstetrician in OB Critical Care: A Case Study from the James Cook University Hospital. Best Practice & Research Clinical Obstetrics & Gynaecolog, 22, 899-916.
http://dx.doi.org/10.1016/j.bpobgyn.2008.06.007

[19]   Ghazi Tabatabaie, M., Moudi, Z. and Vedadhir, A. (2012) Home Birth and Barriers to Referring Women with Obstetric Complications to Hospitals: A Mixed-Methods Study in Zahedan, Southeastern Iran. Reproductive Health, 9, 5.
http://dx.doi.org/10.1186/1742-4755-9-5

[20]   Dellagi, R.T., Belgacem, I., Hamrouni, M. and Zouari, B.E. (2008) Evaluation of the Maternal Mortality Surveillance System in Public Facilities in Tunisia (1999-2004). Mediterranean Health Journal, 14, 1380-1390.

[21]   Vincent, C., Taylor-Adams, S., Chapman, E.J., Hewett, D., Prior, S. and Strange, P. (2000) How to Investigate and Analyze Clinical Incidents: Clinical Risk Unit and Association of Litigation and Risk Management Protocol. BMJ, 320, 777-781.

 
 
Top