The objective of this study was to develop a structural-cognitive-behavioral model for error analysis of group B streptococcus (GBS) prophylaxis failure, classify delivery cases into this model, and examine compliance with treatment guidelines. A retrospective, cohort study was conducted of women with liveborn pregnancies greater than 24 weeks in April 2018 at a single hospital. We created a structural-cognitive-behavioral model of five assessments for adherence to GBS prophylaxis guidelines and then classified these into four distinct error stages. A descriptive analysis was performed to determine if the pregnancy had a perfect process, a GBS prophylaxis failure, or a fortuitous outcome. There were 313 women who met the study criteria. The rate of GBS positive was 12.8%, negative 37.4%, and unknown 49.8%. The most common errors were cognitive perception errors related to incorrectly documenting GBS status, 57.7% (N = 79). Of these errors, 15.2% (N = 12) led to GBS prophylaxis failure. Perfect outcomes occurred in 62.7% (N = 196) women, GBS prophylaxis failure occurred in 13.7% (N = 43), and fortuitous outcomes occurred in 23.6% (N = 74). In our study, we were able to identify structural, cognitive, and behavioral errors that contribute to GBS prophylaxis failures. In other cases, these errors may contribute to fortuitous outcomes.

We created a model to analyze the structural, cognitive, and behavioral components as detected from electronic health records in the process of group B prophylaxis in pregnant patients. While errors in data availability or documentation were common, comprehension/decision-making errors were most correlated to GBS prophylaxis. Improved techniques for error detection and mitigation will need to be developed.

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research and approved by the University of Texas Health Science Center at Houston Institutional Review Board: Committee for the Protection of Human Subjects (HSC-17–0617).

Departmental at UT Health.

Received: 22 June 2021

Accepted: 08 October 2021

Publication Date:
04 February 2022 (online)

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