Saving lives in maternal cardiac care: A novel approach to safety and excellence

The ‘crossroads’- learning to navigate safely

- By DHARSHAN SILVA

Professor D E Gunatilleke Memorial Oration of the Sri Lanka College of Obstetricians and Gynecologists was delivered by Dr Gamini Galappatthy Senior Consultant Cardiologist at the National Hospital of Sri Lanka.

The crossroads are real — every pregnant woman with heart disease stands at one. Gamini’s use of the metaphor of a dangerous crossroads between pregnancy and heart disease was appropriate and illustrative. Traveling down either road one encounters many inherent dangers but coming to the junction unprepared could end in disaster!. A maternal death is a tragic and largely prevent-able disaster at the cross roads, a majority due to heart disease in Sri Lanka. In addition to snatching a woman’s life in the prime, the socio-economic impact of a maternal death is wide and far reaching. With the right signposts, collaboration, and a shift to proactive safety thinking, the obstetric teams can ensure these women navigate the crossroads safely.

Gamini provided novel insights into the ‘Safety-I’ and ‘Safety-II’ frameworks as applica-ble to maternal cardiac care—emphasizing the importance of learning as done at present, from mistakes, risk identification and error prevention (Safety-I) while also highlighting the need for a broader approach of additionally studying successful practices and successful outcomes (Safety-II) to enhance success in patient care. His emphasized on multidiscipli-nary collaboration, early risk assessments, and optimized treatment protocols as the corner-stones of proactive maternal healthcare.

The concepts of Safety I and Safety II which Gamini highlighted, were first proposed by Professors Erik Hollnagel [Denmark] in a 2013 paper. These are currently being recognized by the World Health Organization (WHO), the National Institute for Clinical Excellence (NICE) UK and the Royal College of Obstetricians and Gynecologists (RCOG), UK.