Impact of the Indicated Delivery Calculator on Obstetric Residents’ Clinical Decision-Making

Abstract

PURPOSE: Evaluating the utility of an indicated delivery calculator (IDC) in assisting residents’ determination of delivery timeline for complex obstetric scenarios. BACKGROUND: The American College of Obstetrics and Gynecologists (ACOG) mobile application includes an IDC to provide decision-making support when considering conditions that may necessitate early delivery. The utility of this IDC has not yet been studied. METHODS: After IRB exemption, obstetric residents at our academic center (n=28) were asked to determine delivery timing for fifteen scenarios, with and without use of the IDC. A mixed effects logistic regression model assessed the change in proportion of test items correct. We conducted semi-structured interviews of the residents’ experience utilizing the calculator. Their responses were subjected to content analysis. RESULTS: Residents’ ability to identify the gestational age at delivery for the obstetric scenarios significantly improved after use of IDC (47% pre to 86% post; p<0.01). Positive feedback included the calculator being “user-friendly,” “convenient,” and “well-organized.” The ability to enter multiple conditions was thought to be the best feature of the application. Residents expressed desire to incorporate this tool into their practice. Criticism about the calculator included desire for more robust yet streamlined complication list, more evidence-based references and elimination of prompt for estimated due date/gestational age. DISCUSSION: ACOG’s IDC was effective in improving accuracy of residents’ clinical decisions regarding delivery timelines for complex obstetric scenarios. Users quickly adapted to the tool and successfully navigated the features. Streamlining the input prompts and complication choice list may improve efficiency and increase use.