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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Documentation improvements following multidisciplinary educational program on electronic fetal heart rate tracings
1Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mvadnais@bidmc.harvard.edu
Summary
A new educational program significantly improved electronic fetal heart rate (FHR) monitoring compliance. The evidence-based, multidisciplinary approach led to a substantial increase in adherence to National Institute of Child Health and Human Development (NICHD) guidelines.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Quality Improvement
- Medical Education
Background:
- Electronic fetal heart rate (FHR) monitoring is critical in obstetrics.
- Compliance with National Institute of Child Health and Human Development (NICHD) guidelines for FHR monitoring is often suboptimal.
- A systematic approach is needed to improve adherence to FHR monitoring standards.
Purpose of the Study:
- To evaluate the effectiveness of a multifaceted, multidisciplinary, evidence-based educational program.
- To enhance compliance with NICHD definitions and the three-tier system for electronic FHR monitoring.
- To assess the impact of the program on clinical documentation practices.
Main Methods:
- Prospective study design incorporating a literature review on change management.
- Development and implementation of an evidence-based educational program.
- Systematic, stratified random chart reviews to assess compliance pre- and post-intervention.
Main Results:
- Documentation compliance for all FHR tracing components and SOAP note categories increased from <1% to 90%.
- Post-intervention, 70% of charts had complete FHR tracing documentation.
- The rate of incomplete FHR tracings in SOAP notes decreased from 39% to 1%.
Conclusions:
- Evidence-based strategies are crucial for systemic change in obstetrics.
- Multifaceted, multidisciplinary programs with audits and feedback drive guideline adoption.
- This educational intervention resulted in significant practice change and improved FHR monitoring compliance.
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