Improving the Safety of Labor & Delivery With the Use of Telemedicine

Abstract

INTRODUCTION: In an effort to improve patient safety at our institution, we instituted an electronic Labor and Delivery (eL&D) program for remote electronic fetal monitoring. The aim of this study was to examine nursing attitudes toward eL&D before and after implementation. METHODS: After receiving IRB exemption, labor and delivery nurses completed surveys before and 1 year after initiation of the eL&D. Participation was optional. Surveys were anonymous and included demographic information, personal perceptions of eL&D clinical outcomes and perceptions of changes in workflow. RESULTS: Response rates were 61.7% for initial surveys and 61.2% for final surveys. Questions regarding safety demonstrated a decrease in agreement of eL&D usefulness from initial to follow up surveys. A decrease in the perception that eL&D would improve the number of “good catches” regarding fetal heart tracings; 62.0% (95% CI: 48.1–75.9) versus 32.7% (95% CI: 19.0–46.3) was demonstrated. Questions regarding workflow demonstrated concerns regarding interference with bedside nursing No increase in work load was perceived between the two surveys. Open ended comments expressed concern about eL&D taking away floor staff, eL&D being used as a chart auditing system, and the belief that eL&D would cause interruptions during emergency situations. Overall, 26.5% of respondents felt that eL&D should continue. CONCLUSION: Labor and Delivery nursing staff perceptions suggest limited nursing support of eL&D. These findings should be considered in determining future dissemination plans.