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Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes
Author(s) -
Burstein Paul D.,
Zalenski David M.,
Edwards John L.,
Rafi Ishrat Z.,
Darden Jennifer F.,
Firneno Cassandra,
Santos Palmira
Publication year - 2016
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12589
Subject(s) - shoulder dystocia , documentation , medicine , protocol (science) , data collection , standardization , teamwork , medical education , nursing , pregnancy , alternative medicine , computer science , statistics , genetics , mathematics , pathology , political science , law , biology , programming language , operating system
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.