HANYS/ACOG/NYSDOH New York State’s Obstetric Safety Initiative: Providing Excellence in Electronic Fetal Monitoring (EFM)
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The New York State Obstetric Safety Initiative sets out to provide multi-disciplinary obstetric teams across New York State with vital training on how to interpret, communicate, and effectively respond to FHR tracings. Our goal was for obstetric teams to consistently use a standardized approach to EFM interpretation and management, thereby improving fetal outcomes and reducing liability exposure for hospitals and providers.
This Initiative was a collaboration between the Healthcare Educational and Research Fund, Inc. (HERF), an educational affiliate of the Healthcare Association of New York State (HANYS), the American Congress of Obstetricians and Gynecologists (ACOG), District II, and the New York State Department of Health (DOH). Initiative funding was provided by the New York State Health Foundation. The Initiative was also guided by a multi-disciplinary EFM Task Force of expert clinicians and hospital administrators with funding awarded through the New York State Health Foundation.
Through regional train-the-trainer education programs held during the summer of 2009 hospital obstetric teams were provided education to train hospital clinicians to standardize interpretation, communication and management of FHR tracings. 86 hospitals participated in the entire two year program. The programs were presented by nationally-renowned faculty in EFM education and its legal implications, David Miller, MD, FACOG, and Lisa Miller, CNM, JD.
During the train-the-trainer programs, participants learned how to implement a standardized, evidence-based approach to EFM interpretation and management within their hospitals; overcome implementation barriers by applying crew resource management principles; identify essential elements of documentation related to EFM charting and, describe key legal elements and factors critical to accuracy during a deposition. A resource kit, complete with slide presentations, post-test questions and research materials were provided to participants to help them disseminate the training to their obstetric colleagues on-site in the hospitals.
This Initiative is one component of a broader patient safety agenda in obstetrics aimed at reducing complications and improving birth outcomes in New York State. Participating hospitals have been provided an opportunity to enhance staff competency in the interpretation, communication, and management of FHR tracings based on the standardized nomenclature. Hospitals participating in this patient safety collaborative identified improvements in team communications, clinical practice and technical skills. In doing so, this collaborative is helping to enhance the culture of safety in hospitals.
A special thank you to David Miller, MD, FACOG and Lisa Miller, CNM, JD for participating in the NYS Obstetric Safety Initiative as the faculty for the train-the-trainer courses. Dr. Miller and Ms. Miller were invaluable to the implementation of the Initiative, providing resources and materials and making themselves available for in-person meetings and webconferences. We are grateful to their tireless efforts and support to the Initiative and to the development of this EFM eToolkit.
Thank you to Brian Wagner, MD, FACOG, James Woods, MD, FACOG and Joanne Weinschreider, RN, MS for providing support as clinical advisors throughout the Obstetric Safety Initiative.
Electronic Fetal Monitoring Task Force
Richard L. Berkowitz, MD, FACOG
William Dillon, MD, FACOG
Valerie N. Favata, RN, BSN, MS
Olof Franzon, MD, FACOG
Francine Gallousis, MD, FACOG
Lesli Giglio, RN, MPA
Nicholas Kulbida, MD, FACOG
Dennis Mauricio, MD
Rosemary Reif, RN
Vicki Smith, MS, RNC, WHNP
Ronald Uva, MD, FACOG
Brian Wagner, MD, FACOG
Christa Christakis, MPP
Kathleen Ciccone, RN, MBA
John N. Morley, MD, FACP
Donna Montalto, MPP
Michael Uva, MD