BACKGROUND AND PURPOSE:

• Data suggests that 40.5% of pregnancy-related deaths in the US are preventable
• Schaffer et al. (Obstetrics & Gynecology, 2021) compared malpractice claim rates before and after participation in simulation training

METHODS:

• Retrospective analysis
• Population
  • Obstetrician-gynecologists insured by the same malpractice insurer
  • 10 different institutions around the Boston area | 30% academic
  • Attended one or more simulation training sessions from 2002 to 2019
• Exposure
  • Simulation training
• Study design
  • Simulation focused on team training and crisis management rather than surgical or technical skills
  • High-acuity, low-frequency cases with immediate debriefings: e.g., “acute postpartum maternal compromise requiring life-saving interventions”
  • Claim rates were calculated and expressed as claims per 100 physician coverage years
• Primary outcome
  • Claim rates before and after simulation training
    • Over entire study period
    • 2 years pre and post training
    • 1 year pre and post training
• Secondary outcomes
  • Indemnity payment amounts
  • Percent of claims paid
  • Injury severity

RESULTS:

• 292 physicians
• Compared with presimulation training, malpractice claim rates were significantly lower postsimulation training for
  • The full study period (P<0.001)
    • Pre training: 11.2 claims per 100 physician coverage years
    • Post training: 5.7 claims per 100 physician coverage years
  • The 2 years pre and post training (P=0.043)
    • Pre training: 9.2 per 100 physician coverage years
    • Post training: 5.4 per 100 physician coverage years
• For the 1 year presimulation and postsimulation training comparison, the decrease in claim rates was nonsignificant (P=0.162)
  • Pre training: 8.8 claims per 100 physician coverage years
  • Post training: 5.3 claims per 100 physician coverage years
• Attending more than one simulation session was associated with a greater reduction in claim rates
• Postsimulation claim rates were lower for physicians who attended more than one simulation session (P<0.001)
  • One simulation session: 6.3 per 100 physician coverage years
  • Two simulation sessions: 2.1 per 100 physician coverage years
  • Three simulation sessions: 1.3 per 100 physician coverage years
• Compared with presimulation training, there was no significant difference in
  • The median or mean indemnity paid
  • Percent of claims on which an indemnity payment was made
  • Median severity of injury

CONCLUSION:

• There were significantly fewer malpractice claims after ob-gyns underwent simulation training
• Claim rates were further reduced when physicians attended multiple sessions
• The authors state

Given the ongoing need for improvement in patient safety within obstetrics and gynecology, and the large size of the indemnity awards the risk of which could potentially be reduced after simulation training, the more widespread use of simulation training within obstetrics and gynecology should be considered

Learn More – Primary Sources:

Association of Simulation Training With Rates of Medical Malpractice Claims Among Obstetrician–Gynecologists

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