Improvement of Team Based Communication for Electronic Fetal Monitoring Interpretation and Interventions in Labor and Delivery

Background Team-based education has been shown to improve outcomes in many different fields of medicine. There have been very few studies done on team based education on a Labor and Delivery Unit and the improvements that can be seen. Objectives To compare the rates of optimal care vs suboptimal care provided to patients before and after the implementation of team-based education focused on communication. Data collection and analysis Data for this study was collected through case review of 50 pre-intervention cases and 50 post-intervention cases. Inclusion criteria for the cases included: singleton deliveries, term gestation, and at least one of the following: arterial PH <7.20 or BE>12, 5 min APGAR <7, Operative delivery (C/S or assisted vaginal delivery), and/or unexpected admission to the NICU. Independent events were identified in each case that was reviewed and it was determined whether all or some of optimal care components were implemented. Optimal care was defined as correct: documentation/interpretation, intervention, and communication. Events were compared using Student's t-test and Fischer's Exact test to determine rates of optimal care. Main results There was no significant difference between total optimal care before and after the intervention. Pre-interventions optimal care rate was 35% (out of 170 events) while post-intervention optimal care rate was 31% (out of 129 events). Although total optimal care did not differ between groups based on event type, there were significant improvements in some of the individual components: Communication was significantly better before the intervention in cases of Prolonged deceleration (90% vs 61%). Communication was significantly better after the intervention for recurrent variable decelerations (76% vs 94%). Identification and documentation significantly improved after the intervention for recurrent late decelerations (52% vs 90%). Author's conclusion Optimal care did not improve with the one time use of pilot classes focused on communication. Further pilot classes and further case reviews are needed to be able to show if optimal care will improve as further education and practice are implemented.