545: Putting teamwork to the test: a randomized trial of collaboration in electronic fetal monitoring (EFM)

Abstract

While numerous innovations for improving the performance of EFM have been tested over the past two decades, none have proven effective. The impact of teamwork and collaboration on improving EFM performance is not known. We aimed to assess the effects of collaboration in obstetric providers at YNHH as it pertains to intrapartum EFM. From December 2018 to May 2019 we conducted a randomized trial of obstetric clinicians (MDs, CNMs, RNs) in simulations using the Perinatal Quality Foundation’s (PQF) Fetal Monitoring Credentialing (FMC) exam, a standardized, nationally validated exam that evaluates an examinee’s knowledge and judgement related to intrapartum EFM interpretation and management. After taking an individual baseline exam, participants were randomized to retake the exam, either as an individual or as a member of a team of two individuals. The differences in exam scores were compared between those taking the exam as an individual and as a team. An anonymous post-test survey was conducted to assess participants’ opinions regarding the two exams, our study and teamwork. We recruited 92 participants (42 RNs, 11 CNMs and 39 MDs). Characteristics between the two groups were not significantly different (Table 1). Baseline exam (overall, knowledge and judgement) scores were similar between the two groups (p=0.635, p=0.409, p=0.741). One half retook the exam as an individual (46) and the other half as a member of a team (23 teams of 2 individuals). Exam scores improved more significantly for those participants in a team. When allocated to a team, MD’s showed more improvement in total and knowledge scores, while nurses showed more improvement only in total score (Table 2). More participants in the team group self-reported changing answers on the second exam (68% v 16%). In a simulated environment performance in EFM interpretation and management improves by working as a team. Interdisciplinary teamwork may be one way to improve quality and safety in the use of EFM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)