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ORIGINAL RESEARCH article

Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1412313
This article is part of the Research Topic The Epidemiology of Missed and Delayed Medical Diagnosis: Implications for Health Equity and Public Health View all 10 articles

Development of an Obstetric Hemorrhage Diagnostic Excellence Observation Tool Using a Simulation-Based Modified Delphi Approach

Provisionally accepted
Komal Bajaj Komal Bajaj 1,2Ariel M de Roche Ariel M de Roche 1Anjoinette M Minors Anjoinette M Minors 1,2Michael Meguerdichian Michael Meguerdichian 1,3Rebecca Szabo Rebecca Szabo 4,5Lili S Wei Lili S Wei 6,7,8*
  • 1 New York City Health and Hospitals Corporation, New York, New York, United States
  • 2 Albert Einstein College of Medicine, New York City, New York, United States
  • 3 Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, New York, United States
  • 4 Royal Women's Hospital, Melbourne, Victoria, Australia
  • 5 The University of Melbourne, Parkville, Victoria, Australia
  • 6 Northwell Health, New York, United States
  • 7 Northern Westchester Hospital, Mount Kisco, New York, United States
  • 8 Donald and Barbara Zucker School of Medicine, Hofstra University, Hempstead, New York, United States

The final, formatted version of the article will be published soon.

    Advancing diagnostic excellence in obstetric care is an important strategy to address the maternal morbidity/mortality crisis. The impact of diagnostic safety events on obstetric outcomes such as maternal hemorrhage is understudied.We used a modified Delphi approach to gain consensus on key actions that may impact delayed, missed and incorrect diagnoses and created the Obstetric Hemorrhage Diagnostic Excellence Observation Tool. Simulation was utilized to pilot and modify the tool, which was subsequently applied to in situ simulations in a large urban public health system in New York City.Three content experts with background in simulation and/or quality improvement, across various health care settings, participated in a modified Delphi. Feedback regarding the content, structure, and utility of the form was provided. Twenty-four critical actions were selected to be included in the tool. The Cohen's kappa's coefficient of the observers was 92%.The Obstetric Hemorrhage Diagnostic Excellence Observation Tool is the first of its kind to capture key steps in the diagnostic process of obstetric hemorrhage, as well as debriefings (if performed). A simulation based approach to a modified Delphi may increase feasibility and implementation of a tool focused on capturing diagnostic errors. The next step for this tool is a larger pilot in multiple hospital settings (rural, urban, community and teaching). Additionally, we plan to expand the tool to incorporate other components of the diagnostic safety process such as steps connected to actions before a hemorrhage begins, including identification of risk factors and antepartum care.

    Keywords: OB hemorrhage, diagnostic safety, Diagnostic error, Modified Delphi Methos, Quality Improvement in obstetrics

    Received: 09 Jul 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Bajaj, de Roche, Minors, Meguerdichian, Szabo and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lili S Wei, Northwell Health, New York, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.