BOTJ - Improving health care with best practices

Liability insurance costs are higher for obstetricians than any other medical specialty. While greedy trial lawyers account for their share of costs, the bottom line is that making fewer errors in child birth would lead to fewer lawsuits, and thus lower costs. Doctors, like all of us, stick together and hate to admit, as trained professionals, that some "study" could tell them how to do their job better.

New Practices Reduce Childbirth Risks, today's Best of the Journal article, highlights a number of programs designed to make childbirth safer for both mother and baby. Risk management analysts are learning that: inducing labor early, even a day early, increases the risk of childbirth complications; miscommunications are common between doctors and nurses during childbirth; and labor-inducing drugs pose a greater risk than commonly realized.

"Managed care" has problems, but this is an area where it should shine, finding and encouraging "best practices" by all professionals... especially those small, often overlooked issues which wouldn't be readily apparent as risk factors without looking at large numbers. "It has been hard to get doctors to go along because they don't necessarily believe the risks," said the head of one program to reduce prematurely-induced labor. We all tend to put more faith in our own experiences than in "studies", but when the studies all show the same results, it's time to listen.

There are some early successes. The national average for "incidents" per 1,000 births is 6.34. Some participating hospitals have reduced that figure to 3.3. At the eight-hospital Seton Health Network, birth trauma rates have fallen to almost zero, from 3 per thousand previously in the system. Also at Seton Health, doctors have reduced the use of vacuums and forceps from 7.5% of births to 4% of births since the program launched in January 2004. Intermountain Healthcare, a managed care company, says its program has brought a sharp drop in birth complications and reduced the lengths of stay in labor and delivery... cutting costs by about $500,000 a year.

Better... Stronger... Faster... (and Cheaper...) That's how I want my health care.