Documentation improvements following multidisciplinary educational program on electronic fetal heart rate tracings

Vadnais, Mary; Golen, Toni

doi:10.3109/14767058.2010.529971

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…45,62,63,71,73 The actual numbers participating in each of the studies were often not reported or were unclear. 26,41,44,45,49,50,53,60,[62][63][64][69][70][71][72][73][74]77,78,84 Where participant numbers were reported, they varied from six 51,75 to 4439 81 individuals.…”

Section: Participantsmentioning

confidence: 99%

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Kelly

Redmond

King

et al. 2021

BJOG

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Background Sub-optimal classification, interpretation and response to intrapartum electronic fetal monitoring using cardiotocography are known problems. Training is often recommended as a solution, but there is lack of clarity about the effects of training and which type of training works best.Objectives Systematic review of the effects of training healthcare professionals in intrapartum cardiotocography (PROSPERO protocol: CRD42017064525).

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Section: Participantsmentioning

confidence: 99%

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Kelly

Redmond

King

et al. 2021

BJOG

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“…Our successful approach may serve as a template for future widespread practice changes that are needed in Labor and Delivery units, whether they are driven by new evidence, regulatory pressures, workflow issues, or a combination of these factors. This approach also was successful in our institution when implementing a large-scale process change with the transition to the use of fetal heart rate tracing categories [15]. Several studies have shown that administering antibiotics before skin incision resulted in lower incidence of infectious complications following cesarean delivery [9,10,13].…”

Section: Discussionmentioning

confidence: 96%

Timing of antibiotic administration and infectious morbidity following cesarean delivery: incorporating policy change into workflow

Young

Hacker

Dodge

et al. 2011

Arch Gynecol Obstet

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A multidisciplinary approach was successful in achieving 100% adherence to our institution's policy change regarding timing of prophylactic antibiotics. This approach was necessary in order to incorporate this type of change into the labor and delivery workflow and may serve as a paradigm for success in implementing labor and delivery quality improvement projects. In addition, administration of prophylactic antibiotics before skin incision resulted in fewer surgical-site infections following cesarean delivery. As the clinical and economic impact of surgical-site infections is considerable, the once common practice of administering antibiotics after cord clamping should be avoided.

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“…We addressed the first factor, standardization in interpretation and management of fetal heart rate tracings, in the following ways: 36 We removed “failure to perform a cesarean delivery for non-reassuring fetal heart rate tracing” from our quality measures for our peer review committee and stopped providing provider feedback on this indicator.We educated providers on the use of category systems to describe fetal heart rate tracings. Large posters and pocket cards with category nomenclature and details of each category were available for reference.…”

Section: Methodsmentioning

confidence: 99%

Quality Improvement Initiatives Lead to Reduction in Nulliparous Term Singleton Vertex Cesarean Delivery Rate

Vadnais¹,

Hacker²,

Shah³

et al. 2017

The Joint Commission Journal on Quality and Patient Safety

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Background The nulliparous term singleton vertex (NTSV) cesarean delivery rate has been recognized as a meaningful benchmark. Variation in the NTSV cesarean delivery rate among hospitals and providers suggests many hospitals may be able to safely improve their rates. The NTSV cesarean delivery rate at the authors’ institution was higher than state and national averages. This study was conducted to determine the influence of a set of quality improvement interventions on the NTSV cesarean delivery rate. Methods From 2008 through 2015, at a single tertiary care academic medical center, a multi-strategy approach that included provider education, provider feedback, and implementation of new policies was used to target evidence-based and inferred factors that influence the NTSV cesarean delivery rate. Data on mode of delivery, maternal outcomes, and neonatal outcomes were collected from birth certificates and administrative claims data. The Cochran-Armitage test and linear regression were used to calculate the p-trend for categorical and continuous variables, respectively. Results More than 20,000 NTSV deliveries were analyzed, including more than 15,000 during the intervention period. The NTSV cesarean delivery rate declined from 35% to 21% over eight years. The total cesarean delivery rate declined as well. Increase in meconium aspiration syndrome and maternal transfusion were observed. Conclusion Quality improvement initiatives can decrease the NTSV cesarean delivery rate. Any increased incidence of fetal or maternal complications associated with decreased NTSV cesarean delivery rate should be considered in the context of the risks and benefits of vaginal delivery compared to cesarean delivery.

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Documentation improvements following multidisciplinary educational program on electronic fetal heart rate tracings

Abstract: Incorporating evidence-based strategies for systemic change is an important step in program development in obstetrics. A multifaceted, multi-disciplinary program with frequent audits and feedback can yield high compliance in adoption of guidelines and result in practice change.

Cited by 7 publications

References 12 publications

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta‐analysis

Timing of antibiotic administration and infectious morbidity following cesarean delivery: incorporating policy change into workflow

Quality Improvement Initiatives Lead to Reduction in Nulliparous Term Singleton Vertex Cesarean Delivery Rate

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