Kelly Sarah, Lamé Guillaume, Dixon-Woods Mary, Liberati Elisa, Kyriacou Harry, Dunn Harry, Egerton Alice, Kok Zi Ki, Jones Kathryn, Zheng Xueying Nancy, Kuhn Isla, Draycott Tim J, Winter Cathy, Burt Jenni
Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Strangeways Research Laboratory, Cambridge, UK.
BMJ Open. 2024 Dec 22;14(12):e085827. doi: 10.1136/bmjopen-2024-085827.
Suboptimal intrapartum electronic fetal heart rate monitoring using cardiotocography has remained a persistent problem (EFM-CTG). We aimed to identify the range of influences on the safety of using EFM-CTG in practice.
Scoping review to identify influences related to the practice of intrapartum EFM.
MEDLINE, Embase, CINAHL, Web of Science, Scopus, British Nursing Index, Cochrane Library, from 1 January 2001 to 25 August 2024, and grey literature.
Articles that reported potential influences on the clinical practice of intrapartum EFM-CTG in hospital-based intrapartum maternity care settings, including primary studies, secondary analyses, reviews, reports, conference abstracts and investigations relevant to maternity and obstetrics, in English. Evaluations of technological modifications to traditional EFM-CTG monitoring and analysis were excluded.
We extracted influences on EFM-CTG from the included studies. Findings were synthesised using a best-fit framework approach, structured using an existing 19-domain framework of contributory factors for patient safety incidents in hospitals.
142 articles and 14 reports were included. Our synthesis identified influences on EFM practice across all 19 domains of the contributory factors framework, including those relating to cognitive, social and organisational factors and interactions between professional work and tools used for fetal monitoring.
Reducing avoidable harm associated with electronic fetal monitoring requires a systems approach based on a sound understanding of the full range of influences on practice.
使用胎心监护仪进行产时电子胎心监护（EFM-CTG）效果欠佳一直是个长期存在的问题。我们旨在确定在实际应用中影响EFM-CTG安全性的因素范围。
进行范围综述以确定与产时EFM实践相关的影响因素。
2001年1月1日至2024年8月25日期间的MEDLINE、Embase、CINAHL、Web of Science、Scopus、英国护理索引、Cochrane图书馆以及灰色文献。
报告在医院产时产科护理环境中对产时EFM-CTG临床实践有潜在影响的文章，包括英文的原始研究、二次分析、综述、报告、会议摘要以及与妇产科相关的调查。排除对传统EFM-CTG监测和分析进行技术改进的评估。
我们从纳入的研究中提取对EFM-CTG的影响因素。使用最佳拟合框架方法对研究结果进行综合，该方法采用现有的医院患者安全事件促成因素19领域框架进行构建。
纳入142篇文章和14份报告。我们的综合分析确定了促成因素框架所有19个领域对EFM实践的影响，包括与认知、社会和组织因素以及专业工作与胎儿监测工具之间相互作用相关的影响。
减少与电子胎心监护相关可避免的伤害需要一种基于对实践中各种影响因素全面理解的系统方法。
