Patient Safety and Team Training

In 2000, the publication of the Institute of Medicine (IOM) report To Err Is Human: Building a Safer Health Care System was a seminal event for the health care system in the United States.1 Prior to the publication of this report, many physicians and hospital administrators refused to acknowledge the frequent occurrence of preventable morbidity and mortality and the sad reality that our health care system was not adequately addressing the issue of patient safety. The IOM concluded that tens of thousands of patients were dying each year as a result of medical errors. In the past decade, numerous changes have been endorsed to improve patient safety; these include mandatory minimum nurse-to-patient ratios,2 a reduction in duty hours for resident physicians,3 mandatory time-outs before invasive procedures (to confirm patient identity and the procedure to be performed), and the use of simulation and teamwork training in the medical environment.4,5 Data from high-risk organizations suggest that health care errors do not usually occur because of ill-trained medical personnel but rather result from systems that ‘‘set up’’ both the patient and health care provider. Wu6 has aptly called these health care providers ‘‘second victims.’’ This chapter reviews several modalities that can be used to improve patient safety and reduce the incidence and sequelae of medical errors on the labor and delivery unit.