Simulation and Patient Safety in Obstetrics and Gynecology

  • Angela ChaudhariEmail author
Part of the Comprehensive Healthcare Simulation book series (CHS)


The safety of our patients is top priority and has the potential to be positively impacted by the use of simulation in obstetrics and gynecology. Patient safety is defined by the WHO as “the prevention of errors and adverse events associated with health care” (Patient safety. Accessed 2017). Medical errors and adverse events occur in all areas of medicine. However, attention to these risks is particularly important in our field due to the complex and fast-paced nature of obstetrics and gynecology. Simulation techniques have been used to improve team communication, increase error reporting, and improve management in obstetrics and gynecology and show promise in improving long-term patient outcomes.


Gynecology Obstetrics Patient safety Simulation Medical errors Adverse events 


  1. 1.
    Vincent C. In: Vincent C, editor. Patient safety. Chichester: John Wiley and Sons; 2010.CrossRefGoogle Scholar
  2. 2.
    Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system, I.o. Medicine, Editor. Washington, DC: National Academy Press; 1999.Google Scholar
  3. 3.
    Patient Safety. Accessed 2017.
  4. 4.
    Free from harm accelerating patient safety improvement fifteen years after to err is human. Report of an expert panel convened by the National Patient Safety Foundation; 2015. National Patient Safety Foundation:
  5. 5.
    Emanuel L, Berwick D, Conway J, Combes J, Hatlie M, Leape L, et al. What exactly is patient safety? In advances in patient safety: new directions and alternative approaches. AHRQ; 2008.
  6. 6.
    Gluck PA. Patient safety: some progress and many challenges. Obstet Gynecol. 2012;120(5):1149–59.PubMedGoogle Scholar
  7. 7.
    Gluck PA. Medical error theory. Obstet Gynecol Clin North Am. 2008;35:11–7.CrossRefGoogle Scholar
  8. 8.
    Patient safety primer, safety culture. U.D.o.H.a.H. Services, editor. Agency for Healthcare Research and Quality; 2016.
  9. 9.
    Sheth S, McCarthy E, Kipps AK, et al. Changes in efficiency and safety culture after the integration of an I-PASS supported handoff process. Pediatrics. 2016;137(2):e20150166.CrossRefGoogle Scholar
  10. 10.
    Commission TJ. The essential role of leadership in developing a safety culture, D.o.C.C. cations, editor; 2017. pp. 1–8.Google Scholar
  11. 11.
    Morello RT, Lowthian JA, Barker AL, et al. Strategies for improving patient safety culture in hospital: a systematic review. BMJ Qual Saf. 2013;22:11–8.CrossRefGoogle Scholar
  12. 12.
    Abuhamad A, Grobman W. Patient safety and medical liability. Obstet Gynecol. 2010;116(3):570–7.CrossRefGoogle Scholar
  13. 13.
    Reason JT. Managing the risks of organizational accidents. Aldershot: Ashgate Publishing; 1997.Google Scholar
  14. 14.
    Helmreich RL. On error management: lessons from aviation. BMJ. 2000;320:781–5.CrossRefGoogle Scholar
  15. 15.
    Penney G, Brace V. Near miss audit in obstetrics. Curr Opin Obstet Gynecol. 2007;19:145–50.CrossRefGoogle Scholar
  16. 16.
    Fox MD, Bump GM, Butler GA, Chen LW, Buchert AR. Making residents part of the safety culture: improving error reporting and reducing harms. J Patient Saf. 2017. [Epub ahead of print].
  17. 17.
    Rall M, Gaba D. Human performance and patient safety. In: Miller RD, editor. Miller’s anesthesia. Philadelphia: Elsevier Churchill Livingstone; 2005.Google Scholar
  18. 18.
    Haller G, Garnerin P, Morales M. Effect of crew resource management training in a multidisciplinary obstetrical setting. Int J Qual Health Care. 2008;20(4):254–63.CrossRefGoogle Scholar
  19. 19.
    Pettker CM, Thung S, Raab CA, et al. A comprehensive obstetrics patient safety program improves safety climate and culture. Am J Obstet Gynecol. 2011;204(3):e1–216.CrossRefGoogle Scholar
  20. 20.
    Mancuso MP, Dziadkowiec O, Kleiner C, Halverson-Carpenter K, Link T, Barry J. Crew resource management for obstetric and neonatal teams to improve communication during cesarean births. J Obstet Gynecol Neonatal Nurs. 2016;45(4):502–14.CrossRefGoogle Scholar
  21. 21.
    Nielsen PE, Goldman MB, Mann S, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery. Obstet Gynecol. 2007;109:48–55.CrossRefGoogle Scholar
  22. 22.
    Nielsen PE, Mann S. Team function in obstetrics to reduce errors and improve outcomes. Obstet Gynecol Clin North Am. 2008;35:81–95.CrossRefGoogle Scholar
  23. 23.
    Phipps MG, Lindquist D, McConaughey E, et al. Outcomes from a labor delivery team training program with simulation component. AJOG. 2012;206(1):3–9.CrossRefGoogle Scholar
  24. 24.
    Grobman WA. Shoulder dystocia: simulation and a team centered protocol. Semin Perinatol. 2014;38(4):205–9.CrossRefGoogle Scholar
  25. 25.
    Deering S, Poggi S, Macedonia C, Gherman R, Satin AJ. Improving residency competency in the management of shoulder dystocia with simulation training. Obstet Gynecol. 2004;103(6):1224–8.CrossRefGoogle Scholar
  26. 26.
    Goffman D, Heo H, Pardanani S, Merkatz IR, Bernstein PS. Improving shoulder dystocia management among resident and attending physicians using simulation. Obstet Gynecol. 2008;112(6):1284–7.CrossRefGoogle Scholar
  27. 27.
    Grobman WA, Miller D, Burke C, Hornbogen A, Tam K, Costello R. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol. 2011;205:513–7.CrossRefGoogle Scholar
  28. 28.
    Kim T, Vogel RI, Mackenthun SM, Das K. Rigorous simulation training protocol does not improve maternal and neonatal outcomes from shoulder dystocia. Obstet Gynecol. 2016;127(Suppl 1):3S.CrossRefGoogle Scholar
  29. 29.
    Draycott T, Crofts J, Ash J, Wilson L, Yard E, Sibanda T, Whitelaw A. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol. 2008;112(1):14–20.CrossRefGoogle Scholar
  30. 30.
    Clark EA, Fisher J, Arafeh J, Druzin M. Team training/simulation. Clin Obstet Gynecol. 2010;53(1):265–77.CrossRefGoogle Scholar
  31. 31.
    Fransen AF, van de Ven J, Schuit E, van Tetering AC, Mol BW, Oei SG. Simulation-based team training for multiprofessional obstetric care teams to improve patient outcome: a multicenter, cluster randomised controlled trial. BJOG. 2016;124(4):1471–528.Google Scholar
  32. 32.
    Egenberg S, Øian P, Eggebø TM, Arsenovic MG, Bru LE. Changes in selfefficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage. J Clin Nurs. 2017;26(19–20):3174–87. Epub 2017 Mar 12.CrossRefGoogle Scholar
  33. 33.
    Buchmann EJ, Stones W, Thomas N. Preventing deaths from complications of labor and delivery. Best Pract Res. 2016;36:103–15.CrossRefGoogle Scholar
  34. 34.
    Parker WH. Understanding errors during laparoscopic surgery. Obstet Gynecol Clin. 2010;37(3):437–49.CrossRefGoogle Scholar
  35. 35.
    Ericsson KA. Deliberate practice and acquisition of and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79:S70–81.CrossRefGoogle Scholar
  36. 36.
    Parker WH, Johns A, Hellige J. Avoiding complications of laparoscopic surgery: lessons from cognitive science and crew resource management. J Minim Invasive Gynecol. 2007;14:379–88.CrossRefGoogle Scholar
  37. 37.
    Schwab B, Hungness E, Barsness KA, McGaghie WC. The role of simulation in surgical education. J Laparoendosc Adv Surg Tech A. 2017;27(5):450–4. Epub 2017 Jan 24.CrossRefGoogle Scholar
  38. 38.
    Feldman LS, Hagarty S, Ghitulescu G, et al. Relationship between objective assessment of technical skills and subjective in training evaluations in surgical residents. J Am Coll Surg. 2004;198:105–10.CrossRefGoogle Scholar
  39. 39.
    Sroka G, Feldman L, Vassiliou MC. Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room- a randomized control trial. Am J Surg. 2010;199:115–20.CrossRefGoogle Scholar
  40. 40.
    Derevianko AY, Schwaitzberg SD, Tsuda S, Barrios L, Brooks DC, Callery MP, Fobert D, Irias N, Rattner DW, Jones DB. Malpractice carrier underwrites fundamentals of laparoscopic surgery training and testing: a benchmark of patient safety. Surg Endosc. 2010;24(3):616–23.CrossRefGoogle Scholar
  41. 41.
    Schiff L, Tsafrir Z, Aoun J, Taylor A, Theoharis E, Eisenstein D. Quality of communication in robotic surgery and surgical outcomes. JSLS. 2016;20(3):e2016.00026.CrossRefGoogle Scholar
  42. 42.
    Liberman D, Trinh QD, Jeldres C, Valiquette L, Zorn KC. Training and outcome monitoring in robotic urologic surgery. Urology. 2011;9(1):17–22.PubMedGoogle Scholar
  43. 43.
    Chi AM, Curran DS, Morgan DM, Fenner DE, Swenson CW. Universal cystoscopy after benign hysterectomy: examining the effects of an institutional policy. Obstet Gynecol. 2016;127(2):369–75.CrossRefGoogle Scholar
  44. 44.
    Haynes AB, Weiser TG, Berry WR. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–9.CrossRefGoogle Scholar
  45. 45.
    Varela E, Michael Brunt L. SAGES laparoscopic surgery checklist. In: Tichansky MJ, David S, Jones DB, editors. The SAGES manual of quality, outcomes and patient safety. New York: Springer Science and Business Media; 2012.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Minimally Invasive Gynecology, Fellowship in Minimally Invasive Gynecologic Surgery, Department of Obstetrics and GynecologyNorthwestern University, Feinberg School of MedicineChicagoUSA

Personalised recommendations