Cognitive Reliability and Error Analysis in the Vaginal and Cesarean Delivery Process
Sajjad Farhadi, Maryam Zamani, Reza Esmaeili, Faezeh Khoshkhoo Kakhki, Fatemeh Naeim Abadi, Zeinab Khodabandeh, Mahdi JalaliAbstract
Aim:
The maternity ward is one of the most error-prone hospital departments due to its complex, high-stress environment. Human errors during delivery, particularly cognitive failures, can seriously impact maternal and neonatal outcomes. This study evaluates cognitive reliability during vaginal and cesarean deliveries to improve patient safety.
Methods:
A descriptive and cross-sectional study was conducted in the gynecology and obstetrics department of a tertiary hospital in Nishapur County, Iran, in 2023. A risk assessment using five key variables was performed to identify critical procedures. Pareto analysis was used to prioritize them, followed by the application of the Extended Cognitive Reliability and Error Analysis Method (CREAM) technique to estimate the cognitive failure probabilities (CFPs) of specific tasks and subtasks. In brief, Extended CREAM involved identifying task steps, assessing common performance conditions (CPCs) for each task, and combining CPC scores to calculate adjusted CFPs.
Results:
A total of 15 processes were identified, of which 3 were determined to be critical. The highest CFPs were found in “calculating the drug dose and determining the method of administration” (6.35E-2) and “drug recalculation and ensuring the method of administration” (5.02E-2). A total of 47 errors were detected, with 61% related to execution and 23.5% to observation.
Conclusion:
Focusing on high-risk processes such as woman CPR, neonatal CPR, and stopping PPH is vital in reducing cognitive errors in maternity care. Extended CREAM provides a valuable tool for identifying such tasks and enhancing safety.