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Progress in Patient Safety and Quality in Maternal–Fetal Medicine
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Progress in Patient Safety and Quality in Maternal–Fetal Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 5047

Special Issue Editor

Dr. Samuel T. Bauer

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, School of Medicine, Duke University, Durham, NC, USA
Interests: maternal–fetal medicine; maternity; fetus; pregnancy; patient safety

Special Issue Information

Dear Colleagues,

This Special Issue aims to compile original research and review articles focused on enhancing patient safety and clincial quality improvement relevant to pregnancy and postpartum care. We welcome submissions on a wide variety of topics related to clinical quality and safety, including but not limited to:

  • Medical error;
  • Diagnostic error;
  • Adverse events;
  • Disclosure and reporting;
  • Model for improvement;
  • Implementation science;
  • Health equity;
  • Social drivers of health;
  • Team building and communication;
  • Care handoffs;
  • Simulation and drills.

This Special Issue is particularly interested in articles that highlight clinical quality improvement projects and initiatives aimed at enhancing patient safety and quality within maternal–fetal medicine. Authors are encouraged to submit their research and findings related to these topics to contribute to the advancement of patient safety and quality.

Dr. Samuel T. Bauer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • maternal–fetal medicine
  • pregnancy
  • postpartum
  • medical error
  • maternity
  • fetus

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (5 papers)

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Research

Jump to: Review, Other

14 pages, 442 KiB  
Article
Quantitative Approach to Quality Review of Prenatal Ultrasound Examinations: Estimated Fetal Weight and Fetal Sex
by C. Andrew Combs, Ryan C. Lee, Sarah Y. Lee, Sushma Amara and Olaide Ashimi Balogun
J. Clin. Med. 2024, 13(22), 6895; https://doi.org/10.3390/jcm13226895 - 16 Nov 2024
Viewed by 432
Abstract
Background/Objectives: Systematic quality review of ultrasound exams is recommended to ensure accurate diagnosis. Our primary objectives were to develop a quantitative method for quality review of estimated fetal weight (EFW) and to assess the accuracy of EFW for an entire practice and [...] Read more.
Background/Objectives: Systematic quality review of ultrasound exams is recommended to ensure accurate diagnosis. Our primary objectives were to develop a quantitative method for quality review of estimated fetal weight (EFW) and to assess the accuracy of EFW for an entire practice and for individual personnel. A secondary objective was to evaluate the accuracy of fetal sex determination. Methods: This is a retrospective cohort study. Eligible ultrasound exams included singleton pregnancies with live birth and known birth weight (BW). A published method was used to predict BW from EFW for exams with ultrasound-to-delivery intervals of up to 12 weeks. Mean error and median absolute error (AE) were compared between different personnel. Image audits were performed for exams with AE > 30% and exams with reported fetal sex different than newborn sex. Results: We analyzed 1938 exams from 890 patients. In the last exam before birth, the median AE was 5.9%, and the predicted BW was within ±20% of the actual BW in 97.2% of patients. AE was >30% in 28 exams (1.4%); image audit found correct caliper placement in all 28. Only two patients (0.2%) had AE > 30% on the last exam before birth. One sonographer systematically over-measured head and abdominal circumferences, leading to EFWs that were overestimated. Reported fetal sex differed from newborn sex in seven exams (0.4%) and five patients (0.6%). Images in four of these patients were annotated with the correct fetal sex, but a clerical error was made in the report. In one patient, an unclear image was labeled “probably female”, but the newborn was male. Conclusions: The accuracy of EFW in this practice was similar to literature reports. The quantitative analysis identified a sonographer with outlier measurements. Time-consuming image audits could be focused on a small number of exams with large errors. We suggest some enhancements to ultrasound reporting software that may help to reduce clerical errors. We provide tools to help other practices perform similar quality reviews. Full article
(This article belongs to the Special Issue Progress in Patient Safety and Quality in Maternal–Fetal Medicine)
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13 pages, 3011 KiB  
Article
Quantitative Approach to Quality Review of Prenatal Ultrasound Examinations: Fetal Biometry
by C. Andrew Combs, Sushma Amara, Carolyn Kline, Olaide Ashimi Balogun and Zachary S. Bowman
J. Clin. Med. 2024, 13(16), 4860; https://doi.org/10.3390/jcm13164860 - 17 Aug 2024
Viewed by 825
Abstract
Background/Objectives: To evaluate the quality of an ultrasound practice, both large-scale and focused audits are recommended by professional organizations, but such audits can be time-consuming, inefficient, and expensive. Our objective was to develop a time-efficient, quantitative, objective, large-scale method to evaluate fetal [...] Read more.
Background/Objectives: To evaluate the quality of an ultrasound practice, both large-scale and focused audits are recommended by professional organizations, but such audits can be time-consuming, inefficient, and expensive. Our objective was to develop a time-efficient, quantitative, objective, large-scale method to evaluate fetal biometry measurements for an entire practice, combined with a process for focused image review for personnel whose measurements are outliers. Methods: Ultrasound exam data for a full year are exported from commercial ultrasound reporting software to a statistical package. Fetal biometry measurements are converted to z-scores to standardize across gestational ages. For a large-scale audit, sonographer mean z-scores are compared using analysis of variance (ANOVA) with Scheffe multiple comparisons test. A focused image review is performed on a random sample of exams for sonographers whose mean z-scores differ significantly from the practice mean. A similar large-scale audit is performed, comparing physician mean z-scores. Results: Using fetal abdominal circumference measurements as an example, significant differences between sonographer mean z-scores are readily identified by the ANOVA and Scheffe test. A method is described for the blinded image audit of sonographers with outlier mean z-scores. Examples are also given for the identification and interpretation of several types of systematic errors that are unlikely to be detectable by image review, including z-scores with large or small standard deviations and physicians with outlier mean z-scores. Conclusions: The large-scale quantitative analysis provides an overview of the biometry measurements of all the sonographers and physicians in a practice, so that image audits can be focused on those whose measurements are outliers. The analysis takes little time to perform after initial development and avoids the time, complexity, and expense of auditing providers whose measurements fall within the expected range. We encourage commercial software developers to include tools in their ultrasound reporting software to facilitate such quantitative reviews. Full article
(This article belongs to the Special Issue Progress in Patient Safety and Quality in Maternal–Fetal Medicine)
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10 pages, 1445 KiB  
Article
Adherence to Labor Arrest and Failed Induction of Labor Guidelines: The Impact of a Quality-Improvement Educational Intervention
by Jennifer J. M. Cate, Christopher K. Arkfeld, Meagan Campol, Katherine H. Campbell, Christian M. Pettker and Jessica L. Illuzzi
J. Clin. Med. 2024, 13(16), 4720; https://doi.org/10.3390/jcm13164720 - 12 Aug 2024
Viewed by 869
Abstract
Background/Objective: To evaluate adherence to labor arrest and failed induction of labor (IOL) criteria in nulliparous, term, singleton, and vertex (NTSV) cesarean deliveries at an academic medical center and to measure the impact of a quality-improvement educational initiative that focused on obstetric provider [...] Read more.
Background/Objective: To evaluate adherence to labor arrest and failed induction of labor (IOL) criteria in nulliparous, term, singleton, and vertex (NTSV) cesarean deliveries at an academic medical center and to measure the impact of a quality-improvement educational initiative that focused on obstetric provider education of modern labor arrest and failed IOL criteria. Methods: This is a retrospective cohort study using electronic health record (EHR) data with a pre- (1 September 2018–30 September 2019) and post-intervention (1 October 2019–31 March 2020) study design of all NTSV cesarean deliveries for labor arrest or failed IOL performed at an academic medical center in the northeastern United States. The quality-improvement educational intervention consisted of the distribution of educational pocket cards outlining modern labor arrest and failed IOL criteria to obstetric providers. Outcomes included adherence to labor arrest and failed IOL criteria pre- and post-intervention with secondary outcomes evaluating adherence by provider type (Maternal–Fetal Medicine (MFM) or generalist obstetrician). Descriptive and bivariate statistics were used in the analysis. Results: Pre-intervention, 272 NTSV cesarean deliveries were performed for labor arrest or failed IOL versus 92 post-intervention. Adherence improved post-intervention amongst failed IOL (OR 6.5, CI 1.8–23.8), first-stage arrest (OR 4.5, CI 2.2–10.8) and second-stage arrest (OR 3.7, CI 1.5–9.4). When comparing provider type, MFM physicians were more likely to be adherent to labor arrest and failed IOL criteria compared to generalist obstetricians pre-intervention (OR 3.1, CI 1.7–5.5); however, post-intervention, there was no longer a difference in adherence (OR 3.3, CI 0.9–12.3). Conclusions: Adherence to labor arrest criteria was suboptimal in the pre-intervention period; however, a targeted quality-improvement educational intervention improved adherence rates to labor arrest and failed IOL criteria among obstetric providers. Full article
(This article belongs to the Special Issue Progress in Patient Safety and Quality in Maternal–Fetal Medicine)
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Review

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11 pages, 587 KiB  
Review
Diagnostic Errors in Obstetric Morbidity and Mortality: Methods for and Challenges in Seeking Diagnostic Excellence
by Nicole M. Krenitsky, India Perez-Urbano and Dena Goffman
J. Clin. Med. 2024, 13(14), 4245; https://doi.org/10.3390/jcm13144245 - 20 Jul 2024
Viewed by 986
Abstract
Pregnancy-related morbidity and mortality remain high across the United States, with the majority of deaths being deemed preventable. Misdiagnosis and delay in diagnosis are thought to be significant contributors to preventable harm. These diagnostic errors in obstetrics are understudied. Presented here are five [...] Read more.
Pregnancy-related morbidity and mortality remain high across the United States, with the majority of deaths being deemed preventable. Misdiagnosis and delay in diagnosis are thought to be significant contributors to preventable harm. These diagnostic errors in obstetrics are understudied. Presented here are five selected research methods to ascertain the rates of and harm associated with diagnostic errors and the pros and cons of each. These methodologies include clinicopathologic autopsy studies, retrospective chart reviews based on clinical criteria, obstetric simulations, pregnancy-related harm case reviews, and malpractice and administrative claim database research. We then present a framework for a future study of diagnostic errors and the pursuit of diagnostic excellence in obstetrics: (1) defining and capturing diagnostic errors, (2) targeting bias in diagnostic processes, (3) implementing and monitoring safety bundles, (4) leveraging electronic health record triggers for case reviews, (5) improving diagnostic skills via simulation training, and (6) publishing error rates and reduction strategies. Evaluation of the effectiveness of this framework to ascertain diagnostic error rates, as well as its impact on patient outcomes, is required. Full article
(This article belongs to the Special Issue Progress in Patient Safety and Quality in Maternal–Fetal Medicine)
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Other

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13 pages, 1672 KiB  
Perspective
Severe Hypertension in Pregnancy: Progress Made and Future Directions for Patient Safety, Quality Improvement, and Implementation of a Patient Safety Bundle
by Alissa Prior, Isabel Taylor, Kelly S. Gibson and Christie Allen
J. Clin. Med. 2024, 13(17), 4973; https://doi.org/10.3390/jcm13174973 - 23 Aug 2024
Cited by 1 | Viewed by 1392
Abstract
Hypertensive disorders of pregnancy account for approximately 5% of pregnancy-related deaths in the United States and are one of the leading causes of maternal morbidity. Focus on improving patient outcomes in the setting of hypertensive disorders of pregnancy has increased in recent years, [...] Read more.
Hypertensive disorders of pregnancy account for approximately 5% of pregnancy-related deaths in the United States and are one of the leading causes of maternal morbidity. Focus on improving patient outcomes in the setting of hypertensive disorders of pregnancy has increased in recent years, and quality improvement initiatives have been implemented across the United States. This paper discusses patient safety and quality initiatives for hypertensive disorders of pregnancy, with an emphasis on progress made and a patient safety tool: the Alliance for Innovation on Maternal Health’s Severe Hypertension in Pregnancy patient safety bundle. Future patient safety and quality directions for the treatment of hypertensive disorders of pregnancy will be reviewed. Full article
(This article belongs to the Special Issue Progress in Patient Safety and Quality in Maternal–Fetal Medicine)
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