Transforming Obstetric Safety: The BDMS Safe OB Program as a System-Level Model for Sustainable Improvement in Maternal and Neonatal Outcomes

Abstract

OBJECTIVES: To describe the implementation and outcomes of a systemlevel quality improvement program designed to reduce postpartum hemorrhage (PPH), neonatal sepsis, and neonatal mortality across the Bangkok Dusit Medical Services (BDMS) network. MATERIALS AND METHODS: This multicenter quality improvement report describes the Safe Obstetrics and Delivery (Safe OB) Program, implemented across 44 BDMS hospitals in 2024 in response to increasing rates of PPH, neonatal sepsis, and neonatal mortality during 2022–2023. The program incorporated standardized clinical protocols, simulation-based training, maternal health education, telemedicine, and digital monitoring. Process and clinical outcomes were monitored through a centralized Business Intelligence system, and program compliance was incorporated into hospital performance evaluations. RESULTS: Among 3,792 deliveries reviewed in 2024, 67% of cesarean deliveries and 38% of vaginal deliveries involved high-risk pregnancies. Screening rates increased for gestational diabetes mellitus (GDM) (89% to 94%), Down syndrome (68% to 85%), fetal chromosomal abnormalities (50% to 100%), and group B Streptococcus (43% to 53%). Neonatal sepsis decreased from 4.69% to 3.57%, while the combined neonatal mortality and stillbirth rate decreased from 1.15 to 0.75 per 1,000 births. PPH decreased by 40% following cesarean delivery and by 15% following vaginal delivery. CONCLUSION: The BDMS Safe OB Program demonstrates that structured risk management—combining standardized clinical care, technology-enabled monitoring, and multidisciplinary collaboration—can improve maternal and neonatal outcomes across a large private healthcare network.