The American College of Obstetricians and Gynecologists MEDICAL-LEGAL ISSUES IN OBSTETRIC PRACTICE - PowerPoint PPT Presentation

1 / 24
About This Presentation
Title:

The American College of Obstetricians and Gynecologists MEDICAL-LEGAL ISSUES IN OBSTETRIC PRACTICE

Description:

... before operative procedure Periodic Mock Drills responding to simulated emergencies Already ... Emergency C/S and Shoulder Dystocia Drills Presidential ... – PowerPoint PPT presentation

Number of Views:455
Avg rating:3.0/5.0
Slides: 25
Provided by: DonnaKo
Category:

less

Transcript and Presenter's Notes

Title: The American College of Obstetricians and Gynecologists MEDICAL-LEGAL ISSUES IN OBSTETRIC PRACTICE


1
The American College of Obstetricians and
Gynecologists MEDICAL-LEGAL ISSUES IN
OBSTETRIC PRACTICE
  • Douglas H. Kirkpatrick, MD, FACOG
  • Immediate Past President, ACOG

2
WHAT IS THE ROLE OF ACOG IN EDUCATION REGARDING
CURRENT PRACTICE?
3
What is the Role of ACOG in Education Regarding
Current Practice?
  • Conclusion
  • Role Huge!
  • Impact ACOG widely respected nationally and
    internationally for its informational content

4
Brief History of ACOG
  • 1951 American Academy of Ob-Gyn
  • Incorporated in Chicago
  • Restricted membership
  • 1956 American College of Ob-Gyn
  • Open membership
  • 1981 ACOG moved to Washington, DC
  • 2010 53,000 members
  • 50 male / 50 female

5
ACOGs Educational Committees
  • 25 committees ranging from Adolescent Health Care
    to Health Care for Underserved Women to Ethics to
    Obstetrical Practice to Patient Safety
  • Meet face to face twice a year
  • Produce new documents and review older ones
    (every 5 to 6 years)

6
Practice Bulletins
  • Represent highest level of evidence-based
    medicine
  • Currently 44 OB Practice Bulletins
    34 GYN Practice Bulletins
  • OB examples
  • Intrapartum Fetal Heart Rate Monitoring
  • Management of Preterm Labor
  • Perinatal Care at the Threshold of Viability

7
Committee Opinions
  • Give timely info on clinical management issues
  • Represent views of sponsoring committee based on
    interpretation of published data in peer-reviewed
    journals
  • Currently 43 Committee Opinions in OB
  • Examples
  • Cesarean Section Delivery on Maternal Request
  • Prevention of Early Onset Group B Strep Disease
    in Newborn
  • Scheduled Cesarean Section and Prevention of
    Vertical Transmission of HIV

8
ACOGs Journal Obstetrics and Gynecology (The
Green Journal)
  • Most widely read journal in our specialty in the
    world
  • Testimony of strength of ACOGs educational
    material
  • Many Latin American countries join ACOG for
    educational benefit
  • Central America/South America/Dominican Republic
  • ACOG provides translation into Spanish

9
Important ACOG Documents Over Past
Decade
  • Best Practice Neonatal Encephalopathy and
    Cerebral Palsy (ACOG/AAP 2003)
  • Vaginal Birth After Cesarean Section (July 1999)
  • Induction of Labor (August 2009)

10
VBAC Document
  • 1989 ACOG recommended VBAC enthusiastically
  • 1999 Physician immediately available due to
    published uterine rupture rate of 1 with patient
    in labor
  • Resulted in huge pendulum shift

11
VBAC Statistics
  • 70 success of vaginal delivery with VBAC
  • Problem 20 failed subsequent C/S result in
    complications with mom and baby
  • Problem with rupture 10 25 catastrophic with
    fetal loss or neurologic impairment
  • 1/500 risk newborn catastrophe with VBAC labor

12
VBAC (cont.)
  • 2002 ACOG extensive Informed Consent for
    patient decision of VBAC including death or
    brain damage to baby with uterine rupture
  • 1999 to present biggest barrier OB on L D
    24/7
  • In community hospitals, economics do not work
  • Pendulum swings to almost no VBACS in community
    hospitals
  • Problem huge in western US with large rural
    states
  • VBACs now done in worse case scenario at home
    with untrained lay midwife

13
VBAC (cont.)
  • 2009 new generation of physicians
    lifestyle over practice
  • New job laborist / hospitalist / nocturalist
  • Community hospitals with large OB volume employ
    laborist shift work
  • Suspect pendulum for VBAC deliveries will return
  • With 24/7 coverage can offer VBAC
  • Decision time to delivery time yields
    consistently good outcomes for mom and baby

14
VBAC (cont.)
  • Above reflects how single ACOG document in 1999
    markedly changed physician practice behavior

15
Induction of Labor
  • 2009 25 of women with medical or elective
    induction of labor
  • 10 elective inductions
  • oxytocin discovered and used in 1948
  • 1990 12 inductions medical elective
  • Medical inductions for health of mom or baby
  • High blood pressure
  • Uterine infection (chorioamnionitis)
  • Premature rupture of membrane
  • Elective patient preference/physician practice
    style
  • History of rapid labors
  • Long distance from hospital

16
Elective Inductions
  • Why the fuss?
  • For every week before 39 weeks increase
    Admission to NICU (breathing disorders)
  • 37 weeks 8/1000
  • 38 weeks 5/1000
  • 39 weeks 3/1000
  • Newspapers, including Denver Post (October 2009)
  • Preemies inducing tighten delivery rules
  • Avoid delivering late preemies
  • 2009 ACOG emphasized following induction
    guidelines including NO elective inductions
    before 39 weeks

17
Elective Inductions (Magee Womens)
  • Lessons in change of physician behavior
    Magee Womens, Pittsburgh
    (9,300 del/yr with 140 practicing physicians)
  • 2003 induction rate 28
  • 2004 physician education on ACOG Practice
    Bulletin
  • No inductions before 39 weeks cervix had to be
    favorable
  • Education repetitive with one-on-one physician
    communication
  • 2006 No change in physician practice
  • NOW Above criteria strictly enforced

18
Elective Inductions (Magee Womens)
  • Reduced number of available induction slots on L
    D
  • Monthly review if MD did not adhere
    individual education
  • 2nd non-adherence peer-review letter sent to
    MD and VP Medical Affairs/ part of MDs
    re-credentialing file
  • Results
  • Induction rate decreased from 28 to 16
  • C/S rate for electively-induced nullips 35
    (2004)
  • C/S rate for electively-induced nullips 13.8
    (2006) (Identical to C/S rate for laboring
    nullips)

19
Great Study on Physician Behavior
  • First Conclusion
  • Relatively long time to effect change
  • Once incentives or disincentives developed
    behavior change occurred

20
ACOGs Practice Bulletin on Induction of Labor
  • Second Conclusion
  • With adoption of Induction of Labor Guidelines
    improved clinical outcomes

21
Future Practice of Medicine
  • Evidence-Based Clinical Practice Guidelines
  • Challenges
  • Accessible to MDs
  • Clear and applicable
  • Involve all stakeholders
  • Ultimate improvement in health care

22
Presidential Initiative 2009 Example of
Practice Guidelines
  • Task Force Patient Safety in Office Setting
  • Focused on increasing number of operative
    procedures imported from outpatient OR to office
  • Institute Check Lists (like FAA) before operative
    procedure
  • Periodic Mock Drills responding to simulated
    emergencies
  • Already doing on L D Emergency C/S and
    Shoulder Dystocia Drills

23
Presidential Initiative (cont.)
  • Primary barrier
  • Convincing physicians that patient safety
    supercedes all other priorities in practice
  • With patient safety 1, culture of change will
    deliver the highest quality of medical care
  • Secondary barrier
  • Ability to report errors in blameless culture
    (like FAA)
  • Need to learn from one another so history is not
    repeated
  • 2005 Legislation Patient Safety and Quality
    Improvement Act was passed. Developing rules
    regulations for implementation.

24
The American College of Obstetricians and
Gynecologists MEDICAL-LEGAL ISSUES IN
OBSTETRIC PRACTICE
  • Douglas H. Kirkpatrick, MD, FACOG
  • Immediate Past President, ACOG
Write a Comment
User Comments (0)
About PowerShow.com