Development of a clinical decision support tool and order set for stillbirth and second-trimester fetal death using knowledge translation principles

Abstract

<h3>Objectives</h3> To analyze the development of an order set and paired clinical decision support tool for management of stillbirth and second-trimester fetal death, using knowledge translation (KT) principles. KT is an iterative process that strengthens health services through synthesis, dissemination, exchange, and application of knowledge into practice. Order sets, as adjuncts to clinical judgement, can be powerful clinical decision support tools—they have been shown to improve adherence to practice guidelines, reduce variations, and improve patient safety. <h3>Methods</h3> The development of the above order set and clinical decision support tool is reviewed, analyzing how the tool fits within the knowledge-to-action KT framework. Process steps within the framework included engaging the provincial perinatal quality assurance committee in a needs assessment, use of a pan-provincial, multidisciplinary working group to adapt knowledge to local context, and planning for future outcome evaluations. <h3>Results</h3> Challenges to KT tool development identified in the investigation of stillbirths and second-trimester fetal deaths in Alberta included existing practice and variations, and the deterministic effect of vital statistics definitions on both research and practice. Strengths included existing multidisciplinary provincial perinatal leadership, investment in technology, and the iterative process used for tool development. <h3>Conclusions</h3> We demonstrate the theoretical basis for utilizing an order set with a paired clinical decision tools as a KT tool for investigation of fetal deaths, and explore system challenges and strengths encountered in its development. Ultimately, this project highlights broader interactions in obstetrics and medicine between KT, health technology and health systems, and quality improvement.