ACOG Releases a Practical Approach to Improving Outcomes

Ob-Gyns Recommend Strategies Regarding Clinical Guidelines and Standardization of Practice

Washington, DC—Providing practice recommendations and evidence-based guidelines in order to help obstetrician-gynecologists improve the health of women is a major part of the mission of the American College of Obstetricians and Gynecologists (the College). Unfortunately, adoption and implementation of those recommendations lags behind their publication. A new Committee Opinion from the College addresses the need for greater use of College documents at the institutional and practice levels.

In order to emphasize the importance of greater implementation of Practice Bulletins, Committee Opinions, Patient Safety Checklists, and more, the College has released an updated Committee Opinion, “Clinical Guidelines and Standardization of Practice to Improve Outcomes.” The Committee Opinion lays out a practical approach to reducing patient harm and improving outcomes through better adoption of evidence-based standards of care.

Specifically, the Committee Opinion addresses the use of protocols and checklists in the standardization of patient care as well as the role of the ob-gyn in both developing guidelines and putting them into practice.

Use of checklists and protocols has long been understood to improve consistency and accuracy among medical professionals, and standardization of care can improve patient outcomes. However, too many physicians are unaware of current guidelines. In order to provide the best care to patients, improved awareness of College publications is essential. The Committee Opinion states that “obstetrician-gynecologists should be familiar with and able to implement the practice recommendations and evidence-based guidelines published by the College.”

To that end, the Committee Opinion includes recommendations to help drive improved awareness among ob-gyns and other health care professionals. It suggests that obstetrician-gynecologists should not only lead the process of developing guidelines, but also act as champions to help create consensus and improve adherence to guidelines and protocols. Collaboration from other health care professionals and team members, as well as patients, is also strongly recommended, in order to ensure that the care team as a whole can move forward with the highest level of care possible.

“As physicians, we need to be mindful that our goal is doing the right thing, for all of the patients, all of the time,” said Peter S. Bernstein, MD, MPH, chair of the College’s Committee on Patient Safety and Quality Control, which developed the Committee Opinion. “When evidence is presented for a particular way to care for a given condition, then we have to ensure that all of the patients get cared for in that manner.”

The Committee Opinion acknowledges that individual patients may require treatment that deviates from the recommended course of action; a patient’s age, ethnicity, weight, medical history and desired outcomes are all factors that a physician must take into consideration. However, performing critical tasks the same way every time can reduce the kind of errors that can compromise patient outcomes.

“Standardization of care in the field of obstetrics and gynecology is an important patient safety concept, and clinical protocols are a vital tool in that effort. However, all patients are not the same and some will require care that departs from those established protocols. This is a concept called necessary clinical variation. It is inevitable and expected,” said John Keats, MD, an Ex-Officio of the College’s Committee on Patient Safety and Quality Improvement, who was instrumental in the development of the recommendations. “The key point is that documentation of why any protocol is not followed is imperative and reasons must be clearly explained in those terms.”

Committee Opinion #629, “Clinical Guidelines and Standardization of Practice to Improve Outcomes,” is published in the April issue of Obstetrics & Gynecology.

The following recommendations are also published in the April issue of Obstetrics & Gynecology:

Practice Bulletin #148 “Thyroid Disease in Pregnancy” (Revised)
ABSTRACT: Uncontrolled thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease and even subclinical maternal thyroid disease on fetal development. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. This document reviews the thyroid-related pathophysiologic changes that occur during pregnancy and the effects of overt and subclinical maternal thyroid disease on maternal and fetal outcomes.

Practice Bulletin #149 “Endometrial Cancer” (Revised)
ABSTRACT: Endometrial carcinoma is the most commonly diagnosed gynecologic malignancy; almost every gynecologist will encounter it. A thorough understanding of the epidemiology, pathophysiology, and diagnostic and management strategies for this type of cancer allows the obstetrician–gynecologist to identify women at increased risk, contribute toward risk reduction, and facilitate early diagnosis. The purpose of this document is to review the current understanding of endometrial cancer and to provide guidelines for management that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 58,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org