Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes. (21st October 2016)

• Record Type: Journal Article
• Authors: Burstein, Paul D.; Zalenski, David M.; Edwards, John L.; Rafi, Ishrat Z.; Darden, Jennifer F.; Firneno, Cassandra; Santos, Palmira
• Other Names: Ridgely M. Susan guestEditor.; Greenberg Michael D. guestEditor.; Clancy Carolyn M. guestEditor.
• Is Part Of: Health services research. Volume 51(2016)Supplement 3
• Page Start: 2472
• Page End: 2486
• Publication Date: 2016-10-21
• Subjects: Shoulder dystocia -- guidelines -- adherence; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12589
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract : Objective: To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. Data Sources/Study Setting: Primary data collection was conducted over 3 years. Implementation of the protocol spanned 13 months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location. Study Design: Case study evaluation methodology was used to examine clinician engagement and protocol adoption. Data Collection Methods: The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file. Data from the labor and delivery notes, medical records, and interviews with labor and delivery teams were gathered and analyzed by the senior investigator. Principal Findings: In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements and in subsequent years, 98 percent completed the follow‐up training. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol. Conclusions: System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.