Increasing compliance with a clinical practice guideline for fetal fibronectin testing and the management of threatened preterm labour: A quality improvement project

Abstract

ObjectiveTo increase adherence to a local hospital clinical practice guideline for the use of fetal fibronectin testing in women presenting with symptoms of threatened preterm labour. Study designA quality improvement project using a multi-faceted implementation strategy. SettingNational Women’s Health, Auckland City Hospital; a tertiary referral maternity unit in Auckland, New Zealand. PopulationAll obstetricians, junior obstetric doctors and hospital employed midwives. MethodsA pre-education audit and survey, compulsory interactive educational intervention with audit feedback and provision of reminders followed by a post-education audit and survey one year later. Main outcome measuresNumber of fetal fibronectin tests performed, proportion of tests performed meeting clinical criteria for testing and proportion of results managed according to hospital guideline. ResultsThere was a 25% increase in the number of tests performed with an increase in the proportion that met clinical criteria for testing, 76% (31/41)–93% (51/55) (OR 4.1, 95% CI 1.2–14.2). Adherence to guidelines for clinical management according to fFN results changed over time, 80% (33/41)–95% (52/55) (OR 4.2, 95% CI 1.04–17.0). Clinician knowledge on some (but not all) indications for fFN testing improved. Education and reminders did not improve understanding of clinical scenarios that may result in a false positive fFN test. ConclusionsA multi-faceted approach of audit and clinician feedback, interactive education and reminders supports the implementation of a clinical practice guideline for the use of fFN as a preterm birth prediction test for women presenting with symptoms of threatened preterm labour.