Do You See What I See? Using Telemedicine in Obstetrics to Improve Patient Safety

Abstract

<h2>Childbearing Poster Presentation</h2><h3>Purpose for the Program</h3> Telemedicine has gained momentum nationally, especially in intensive care settings. Little information is available on remote fetal monitoring. The purpose of this project is to test the use of surveillance of the results of fetal heart tracing monitoring using the telemedicine concept. As a result, we will improve birth outcomes, improve patient safety, minimize medical and legal risks, and reduce preventable neonatal injuries or death. <h3>Proposed Change</h3> Remote fetal monitoring, with an experienced labor and delivery (L&D) nurse, will serve as a second opinion for bedside clinicians. The use of telemedicine in the L&D setting also is useful when pregnant patients are admitted to other units, such as the intensive care unit (ICU). <h3>Implementation, Outcomes, and Evaluation</h3> The L&D department will serve as the pilot for the project. The pilot involves monitoring 20 L&D rooms and 7 triage rooms. E-Care Mobile Carts (cameras) will be used for the visual monitoring of high-risk patients. One L&D registered nurse (RN) will share space in the electronic ICU and be available 24 hours per day, 7 days per week. Before the pilot, data will be obtained on the following outcomes: infants with arterial cord blood pH ≤7.0 or pH 7.01 to 7.09 with base excess ≥–10.0 with transfer to the NICU; unanticipated NICU admission; and 5-minute Apgar score ≤5. For Category III tracing, the following data will be obtained: time of onset to health care provider notification; time from notification to decision for cesarean delivery; time from decision to incision; obstetric TraceVue (OBTV) surveillance of all Category II fetal tracings; number of nursing interventions; and number of electronic L&D nurse interventions. Also, management of tachysystole, good catches, response to alerts, staff mentoring and coaching calls, calls to the electronic L&D, and differences in clinical interpretation will be recorded. After implementation of the pilot program, aggregate measures will be reviewed to determine success. A 6-month period is necessary to determine the potential effect on patient safety measures. <h3>Implications for Nursing Practice</h3> Through these constant, direct nursing observations and interventions there will be a positive effect in the number of good catches, significant safety events, and fetal outcomes. A supporting goal includes timely and appropriate management of Category III heart rate tracings. It is expected that a decrease from time of onset of this tracing to time of decision to incision will decrease. The pilot program also will be considered successful if either the preventable neonatal injuries or deaths decrease.