When The Johns Hopkins Hospital’s malpractice insurer set out to reduce clinical liability risk and advance patient safety, it began by pinpointing the specialties with the most expensive claims. MCIC Vermont found that at the consortium of five academic medical centers it covers, obstetrics shouldered the biggest chunk of the claims payouts—nearly 25 percent, or $35.2 million per year.

So under the insurer’s direction, obstetrics leaders at Hopkins, Yale, Columbia, the University of Rochester and Cornell joined forces to brainstorm a solution.  They unanimously agreed that the best way to curtail claims at their institutions was to hire a clinical nurse specialist whose sole purpose was to promote a culture of safety in obstetrics.

The consortium reasoned that clinical nurse specialists, with their advanced nursing education, have a broader knowledge to zoom in on a particular specialty using a big-picture lens.  They’re skilled in performance improvement and in supporting, mentoring and empowering the nursing staff. And research credits their work with reducing medical complications and increasing patient and staff satisfaction.

Susan Will, a clinical nurse specialist with more than two decades of experience in obstetrics, began in July 2004 as the designated obstetrics patient safety nurse for both The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. What drew her to the role, she says, were the innovative safety campaigns already in place at Hopkins.  She was further motivated by the quality of the staff and the acuity of the patients.

Will jumped right into her new position by conducting teamwork training sessions for labor and delivery staff on both campuses.  The sessions, required for everyone from physicians to housekeepers, aim to improve team communication and decrease hierarchy using techniques borrowed from aviation.

When the training is complete, Will plans to spend more time on the unit to ensure that staff are using their teamwork skills. She’ll also trawl the reports logged with Patient Safety Net for trends that could have a negative impact on safety, such as mislabeled specimens or medication errors.

Currently, Will is collecting such risk data as traumatic birth injuries, uterine rupture and fetal death to establish a baseline.  The data will be benchmarked against similar statistics collected by safety nurses at the other four MCIC consortium institutions.

The consortium’s safety nurses are also collaborating to write an article, “Role of the OB Patient Safety Nurse,” slated for publication in the Journal of Obstetric, Gynecologic and Neonatal Nursing this fall.

-From Hopkins Nurse, Spring 2005

PHOTO:  Susan Will, patient safety nurse