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

Abstract

To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. Primary data collection was conducted over 3years. Implementation of the protocol spanned 13months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location. Case study evaluation methodology was used to examine clinician engagement and protocol adoption. 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. 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. System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.