Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes.

Burstein PD1, Zalenski DM2, Edwards JL3, Rafi IZ4, Darden JF5, Firneno C6, Santos P7.

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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.