Medical liability risks are driving change in ob-gyn care for both physicians and hospitals. According to a poll by the American Congress of Obstetricians and Gynecologists, 51 percent of surveyed ob-gyns reported making changes to their practice, including reducing the number of gynecologic surgeries, dropping obstetrics, favoring cesarean deliveries, or abandoning private practice to become salaried employees of hospitals and other institutions.

The 9,006 participants reported 4,060 liability claims initiated between Jan. 1, 2009, and Dec. 31, 2011, with 42 percent saying one or more claims had been filed against them.

Physicians' limitations on which conditions they treat and which services they perform can create hardships for patients, including lengthy waits for appointments or surgery and little or no access to providers in some areas. Meanwhile, hospitals face a reduced number of patients being referred for care, and more difficulty in recruiting physicians.

To help remedy the situation, the Agency for Healthcare Research and Quality has offered grants for institutions to develop ways that could lower risks associated with deliveries. One recipient, Fairview Health Services in Minneapolis, received a grant to create and test patient care checklists to improve outcomes. Another recipient, Ascension Health in St. Louis, offers e-learning modules on electronic fetal monitoring, in situ simulation education with high-fidelity mannequins, and disclosure communication and cause analysis.

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