BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital.
METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit\'s professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions\' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05.
RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 \"Frequency of adverse events reported\" (from 30.1 to 65.6%, p < 0.001), D3 \"Supervisor/Manager expectations and actions promoting patient safety\" (from 38.0 to 76.8%, p < 0.001), D4 \"Continuous improvement and organizational learning\" (from 37.5 to 41.0%, p < 0.01), D5 \"Teamwork within units\" (from 58.2 to 79.7%, p < 0.01), D6 \"Communication openness\" (from 40.6 to 70.6%, p < 0.001), and D7 \"Non-punitive response to error\" (from 21.1 to 42.7%, p < 0.01), D9 \"Management support for patient safety\" (from 26.4 to 72.8%, p < 0.001), and D10 \"Teamwork across units\" (from 31.4 to 76.2%, p < 0.001).
CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.

BACKGROUND: Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department.
METHODS: This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals (N = 8) and patients (N = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach.
RESULTS: Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: \'structure\', \'culture\', \'education\', \'emotional\', and \'physical and technology\'. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients.
CONCLUSIONS: Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, \'politics\'. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations\' structure, culture and practices.

BACKGROUND: Research on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses\' knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses\' knowledge and attitudes.
METHODS: This study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder.
RESULTS: The results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit.
CONCLUSIONS: The study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

This Medical News article discusses a new report on labor and delivery department closures in the rural US as well as potential financial and workforce solutions.

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department.

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Disparities in maternal morbidity and mortality remain vivid reminders of the role of racism in obstetrics and gynecology. If a serious attempt is to be made to purge medicine of its ongoing role in unequal care, then departments must commit the same intellectual and material resources as they would to the other health challenges in their remit. A division that understands the unique needs and complexities of the specialty, including translating theory into practice, is uniquely positioned to keep health equity as a focus of clinical care, education, research, and community engagement. To achieve reproductive justice, an approach addressing the intersectionality of race, ethnicity and gender identity is critical. In this article, we detailed the ways in which divisions of health equity within departments of obstetrics and gynecology can dismantle impediments to progress and can move our discipline closer to optimal and equitable care for all. We described the unique educational, clinical, research, and innovative community-based activities of these divisions.

BACKGROUND: An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care.
METHODS: Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled.
RESULTS: Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold.
CONCLUSIONS: Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.

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Sepsis caused by methicillin-resistant coagulase-negative staphylococci (MRCoNS) seriously affects the morbidity and mortality of neonates. However, the hand carriage and genotypic diversity of MRCoNS within surgical staff remain unclear in China. In the study, antimicrobial susceptibility tests and genotypic characterisation were applied to MRCoNS. One hundred and one samples were collected from the hands of gynaecological surgical staff. Eighty staphylococcal isolates were identified, of which 75 (94%) were resistant to at least one antibiotic. mecA gene was determined in 50 (62.5%) staphylococcal isolates. Panton-Valentine leukocidin (pvl) and ica genes were determined in 17 (21%) and 12 (15%) staphylococcal isolates, respectively. About 52% of staphylococci carried SCCmec IV and V, followed by SCCmec type I, II, and III (38%). In addition, two new STs types were assigned as ST844 and ST845. The high level of hand MRCoNS colonisation rate in gynaecological surgical staff is of concern, and hand hygiene management should be emphasised among surgical assistants.Impact statementWhat is already known on this subject? Coagulase-negative staphylococci (CoNS) are the predominant cause of neonatal sepsis. Exposure to antimicrobial-resistant CoNS might put neonates at increased risk of infection. However, little is known about the carriage and genetic diversity of methicillin-resistant CoNS (MRCoNS) of gynaecological surgeons and surgical assistants.What do the results of this study add? This is the first study on the molecular characterisation of MRCoNS recovered from gynaecological surgeons and surgical assistants in China. MRCoNS carriage rate in surgical assistants was significantly higher than in surgeons. Seventy-five (94%) coagulase-negative staphylococci were resistant to at least one antibiotic. SCCmec I, II and III was the dominant types identified in MRCoNS that were recovered from surgical staff. Fifty (62.5%) staphylococcal isolates that were recovered from surgical staff harboured the mecA gene. Pathogenic clones of MRCoNS were disseminated in surgical staff, and half of mecA-positive Staphylococcus epidermidis harboured the ica gene.What are the implications of these findings for clinical practice and/or further research? The high level of hand MRCoNS colonisation rate among gynaecological surgical staff is of concern. The alarming outcome of this study suggested that hygiene measures should be emphasised among gynaecological surgical assistants.