Improving Your Practice, Managing Your Risk

Patient Safety Activities and Resources

Several activities and resources are available for your participation and use. The descriptions below show how you and your practice—along with your patient safety efforts—will benefit. If you  are a program insured and would like to access your Practice Improvement secure area, please Log In. Please note that Ob-Gyn Risk Alliance members have access to all ProAssurance “insureds-only” resources in addition to content exclusive to Alliance members.

The activities and resources include:

• Medical Practice Site Survey & Hospital Ob-Focused Risk Mapping (with hospital consent)
• Closed-Case Review
• Patient Safety Information Survey
• Basic Ob Tool Kit
• Ob Risk Management Guidelines
• Risk Resource Phone Consultations
• Future Activities and Resources

Medical Practice Site Survey & Hospital Ob-Focused Risk Mapping

The first step in the process is an on-site practice assessment by a ProAssurance risk management consultant. In this assessment, our consultant will conduct an on-site Medical Practice Site Survey to review your policies, procedures, protocols, clinical competency information in personnel files, health professionals’ credential files, and medical records. Consultants also tour your practice site and conduct interviews with select personnel.
 
This Survey focuses on high-risk processes known to contribute to Ob professional liability claims. These include: communication, documentation, patient tracking and follow-up systems, and staff competency. Following the Survey, the consultant meets with your practice’s designated leadership to review preliminary findings. A written report is sent with observations and recommendations to improve patient care and minimize professional liability risk.
 
Hospital Ob Risk Mapping, when allowed by the hospital, identifies clinical strengths as well as areas in need of improvement. Risk Mapping involves unit observations of patient flow, the environment of care, and whether teamwork is emphasized between professionals and patients.
 
Our review of certain items during Risk Mapping (e.g., policies and procedures, medical records, quality and staff meeting minutes, and labor and delivery and nursery logbooks) provides information on where current safety practices have been implemented and areas that should receive focused safety efforts. Risk Mapping also evaluates medical credentialing processes, initial and ongoing staff competency, and continuing education activities. Focused data collection during the assessment enables organizations to determine where resources could be allocated to initiate positive change.

Contact the Risk Management Department to schedule a Medical Practice Site Survey or hospital Risk Map by calling 800.292.1036 or emailing RMQuestions@ProAssurance.com.


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Closed Case Reviews

The next step in the process is your participation in teleconferences wherein ProAssurance risk management staff present live Closed Case Reviews. Each session will involve discussion of up to three closed Ob cases. With a ProAssurance staff facilitator, you discuss the risk management issues and medical care involved in each case. These Closed Case Studies are not recorded.
 
ProAssurance emails physicians in advance with the session date and time. In addition, you will receive access instructions and “sterilized” information on the cases to be reviewed.

Patient Safety Information Survey

Focused non-punitive reporting of clinical events is essential to improving the quality of patient care. A standardized framework for reporting ensures patient safety and liability risk data is consistent. An ongoing and integral part of the risk management process is your participation in our reporting system which includes a database, data collection, data analysis, and recommendations for change or improvement.
 
Within the insureds-only secure area, a link will take you to an encrypted event reporting system; here you will enter information, in a confidential environment, about important obstetrical issues. These issues include: APGARs, uterine ruptures, induction or augmentation at less than 39 weeks, operative vaginal delivery, emergency C-sections, shoulder dystocia, lacerations, injections, and neurological injuries. Patient-identifying information is not collected. 
 
Our risk management consultants will then analyze the data and generate unique and specific recommendations designed to improve patient outcomes and reduce professional liability risk in your practice. The measures taken to ensure data consistency will help you compare your practice to that of your peers. 
 
While event reporting is a fact-based way to improve the quality of patient care, this system does not replace your duty to report potential claims to ProAssurance’s Claims Department. To report a claim or incident, contact a ProAssurance claims representative by phone at 800.282.6242.

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Basic Ob Tool Kit

As a member of the Ob-Gyn Risk Alliance, you have access to a FREE Basic Ob Tool Kit which will assist you in providing consistent, up-to-date, and quality care for your Ob patients. If you would like to access the Basic Ob Tool Kit within the secure area, please Log In.  

The Basic Ob Tool Kit includes:
 
Patient Care & Management Tools
    An Array of Sample Documentation Forms:  

• Prenatal & postpartum documentation forms                  
• Diagnostic test & referral tracking form
• Patient education form                            
• Kick count form
• Procedure-specific consent forms (normal vaginal delivery, VBAC, labor induction, C-section, etc.)
• Office and after-hours telephone documentation form
• Screening tool for postpartum depression
• Documentation templates for C-section and shoulder dystocia in the hospital setting

• Patient education pamphlets (nutrition, bleeding, etc.)
• Kick count pamphlet
• Smoking cessation
• Assisted deliveries (vacuum-assisted deliveries, use of forceps, etc.)

Practice Management Tools

• Process for withdrawal from care & sample letter
• Telephone triage (sample policy, protocol, & staff skills checklist)
• Sample staff competency assessment tool
• Sample chaperone policy
• Sample patient satisfaction survey tool

Ob Risk Management Guidelines

Our Ob Risk Management Guidelines are available in our secure area to members of the Ob-Gyn Risk Alliance. These guidelines provide you and your staff with a roadmap for reducing liability risk and improving the defensibility of potential claims. Ob patients are a unique population; maternal/fetal clinical status can rapidly change. As such, these guidelines will address issues such as preemptive informed consent discussions in the office setting in anticipation that the plan for a vaginal delivery may change to a C-section.
 
Another Ob-specific issue involves patient confidentiality for minors, while protecting the health of a patient who may not recognize the urgency of their clinical condition. Additional topics include record retention, patient handoffs in an Ob practice, working with mid-level providers, etc.

If you are a member and would like to access the Ob Risk Management Guidelines within the secure area, please Log In.

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Risk Resource Phone Consultations

As an insured, you can receive immediate assistance for your questions about medical professional liability issues Monday through Friday from 8:00 a.m. to 6:00 p.m. (ET). Both phone and email access are available, whichever you prefer: 800.292.1036; RMQuestions@ProAssurance.com.

Future Activities and Resources

Just as medicine is an evolving science, risk management is a continuum. ProAssurance will provide additional risk management resources for your benefit in conjunction with the Ob-Gyn Risk Alliance. Some future activities and resources include:  

• “Safety Culture” Surveys – Hospital & Medical Practice
• Value-Added Physician/Hospital Staff Collaboration Training (with hospital consent)
• Advanced Ob Tool Kit
• Event Management Participation
• Simulation Training