Consent Related Delay in Emergency Obstetric Care as a Sentinel Patient Safety Event: A Risk Governance Commentary from Somalia

This evidence informed commentary addresses consent related delay in emergency obstetric care in Somalia, where clinician recommended escalation may be delayed by family mediated refusal, indecision, or uncertainty about emergency authority. The purpose is to strengthen the conceptual grounding and practical implementation of a risk governance response to this under recognized patient safety problem. The commentary draws on established patient safety concepts, maternal delay models, World Health Organization quality of care and near miss approaches, published evidence from Somali settings, and the Somali regulation on patient rights and responsibilities of healthcare workers. We propose an operational definition of consent related delay as a sentinel patient safety event when it contributes to serious maternal harm or creates substantial risk of such harm. The framework emphasizes timely recognition of contested consent, structured escalation, clear documentation, lawful emergency action, integration into maternal near miss and mortality review, and routine monitoring. This framing may support hospital managers, clinicians, and policymakers to convert a recurring source of avoidable delay into an auditable governance process while preserving respectful patient and family engagement.