Cate Jennifer J M, Arkfeld Christopher K, Campol Meagan, Campbell Katherine H, Pettker Christian M, Illuzzi Jessica L
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA.
Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC 27710, USA.
J Clin Med. 2024 Aug 12;13(16):4720. doi: 10.3390/jcm13164720.
To evaluate adherence to labor arrest and failed induction of labor (IOL) criteria in nulliparous, term, singleton, and vertex (NTSV) cesarean deliveries at an academic medical center and to measure the impact of a quality-improvement educational initiative that focused on obstetric provider education of modern labor arrest and failed IOL criteria. This is a retrospective cohort study using electronic health record (EHR) data with a pre- (1 September 2018-30 September 2019) and post-intervention (1 October 2019-31 March 2020) study design of all NTSV cesarean deliveries for labor arrest or failed IOL performed at an academic medical center in the northeastern United States. The quality-improvement educational intervention consisted of the distribution of educational pocket cards outlining modern labor arrest and failed IOL criteria to obstetric providers. Outcomes included adherence to labor arrest and failed IOL criteria pre- and post-intervention with secondary outcomes evaluating adherence by provider type (Maternal-Fetal Medicine (MFM) or generalist obstetrician). Descriptive and bivariate statistics were used in the analysis. Pre-intervention, 272 NTSV cesarean deliveries were performed for labor arrest or failed IOL versus 92 post-intervention. Adherence improved post-intervention amongst failed IOL (OR 6.5, CI 1.8-23.8), first-stage arrest (OR 4.5, CI 2.2-10.8) and second-stage arrest (OR 3.7, CI 1.5-9.4). When comparing provider type, MFM physicians were more likely to be adherent to labor arrest and failed IOL criteria compared to generalist obstetricians pre-intervention (OR 3.1, CI 1.7-5.5); however, post-intervention, there was no longer a difference in adherence (OR 3.3, CI 0.9-12.3). Adherence to labor arrest criteria was suboptimal in the pre-intervention period; however, a targeted quality-improvement educational intervention improved adherence rates to labor arrest and failed IOL criteria among obstetric providers.
评估美国东北部一家学术医疗中心非初产、足月、单胎且头位（NTSV）剖宫产术中产程停滞和引产失败（IOL）标准的依从性，并衡量一项质量改进教育举措的影响，该举措侧重于对产科医护人员进行现代产程停滞和引产失败标准的教育。这是一项回顾性队列研究，使用电子健康记录（EHR）数据，采用干预前（2018年9月1日至2019年9月30日）和干预后（2019年10月1日至2020年3月31日）的研究设计，研究对象为该学术医疗中心所有因产程停滞或引产失败而进行的NTSV剖宫产。质量改进教育干预措施包括向产科医护人员发放概述现代产程停滞和引产失败标准的教育袖珍卡片。结果包括干预前后对产程停滞和引产失败标准的依从性，次要结果是按医护人员类型（母胎医学（MFM）或普通产科医生）评估依从性。分析中使用了描述性和双变量统计。干预前，有272例因产程停滞或引产失败进行的NTSV剖宫产，干预后为92例。干预后，引产失败（比值比6.5，置信区间1.8 - 23.8）、第一产程停滞（比值比4.5，置信区间2.2 - 10.8）和第二产程停滞（比值比3.7，置信区间1.5 - 9.4）的依从性有所提高。比较医护人员类型时，干预前MFM医生比普通产科医生更有可能遵守产程停滞和引产失败标准（比值比3.1，置信区间1.7 - 5.5）；然而，干预后，依从性不再有差异（比值比3.3，置信区间0.9 - 12.3）。干预前期对产程停滞标准的依从性欠佳；然而，一项有针对性的质量改进教育干预提高了产科医护人员对产程停滞和引产失败标准的依从率。
