Presentation
Applying a systems-level safety framework to identify facilitators and barriers in improving safety in fetal health surveillance using electronic fetal monitoring
SessionPoster Session 1
DescriptionChallenges in intrapartum fetal health surveillance (FHS) using electronic fetal monitoring (EFM) remain a major area of preventable risk and harm for birthing persons and infants. Several approaches may inform understanding of systemic factors that influence safety. For example, analysis of medico-legal claims involving FHS, particularly EFM, reveal a variety of potential contributing factors including interprofessional communication, culture, and teamwork. Capturing the daily interactions between people, tools, tasks, and environments in which EFM is used may reveal deep insights and opportunities to improve safety in FHS in this complex socio-technical system. Healthcare Insurance Reciprocal of Canada (HIROC) engaged in a multi-site pilot study with two of its Subscriber hospitals, Orillia Memorial Soldiers’ Hospital (OSMH) and Royal Victoria Hospital (RVH), to identify opportunities to improve FHS safety in a Canadian perinatal context.
Objective
To investigate barriers and facilitators to fetal health surveillance (FHS) using electronic fetal monitoring (EFM) by applying a systems-level safety framework at two Canadian hospitals that provide perinatal services. The Systems Engineering Initiative for Patient Safety 101 (SEIPS 101) is a framework for modeling components of a healthcare work system, processes and their associated outcomes. This systems-level investigation at OSMH and RVH enabled HIROC human factors specialists in partnership with clinical leaders to identify opportunities to improve safety, and subsequent projects for deeper investigation.
Methods
Two HIROC safety and risk management specialists conducted site visits for four days at OSMH and five days at RVH. The specialists reviewed relevant hospital protocols and procedures, and while on-site, engaged in contextual inquiry, semi-structured interviews and focus groups with 27 and 25 participants, respectively at OSMH and RVH. Participant roles included nurses, midwives, obstetricians and physician assistants to understand current processes, as well as biomed technicians to understand equipment functionality and capabilities. After the site visits were completed, the HIROC specialists analysed the data using the SEIPS 101 framework, specifically using the People-Environments-Tasks-Tools (PETT) tool to identify barriers and facilitators to safe FHS care using EFM.
Results/Learning
The preliminary analysis of the contextual inquiry data, interviews and focus groups revealed several common themes as barriers and facilitators to safe FHS care using EFM. Facilitators included having strong interdisciplinary teamwork and using proper terminology as a standard to describe EFM tracings. Barriers included complex EFM strips that may lead to differing interpretations between healthcare providers. Additionally, unique findings were observed between sites, such as having team members as certified FHS instructors to provide interdisciplinary training and having physician assistants on staff to support both nurses and physicians during perinatal care. These unique findings support the understanding that care and its associated risks are greatly impacted by local context.
Objective
To investigate barriers and facilitators to fetal health surveillance (FHS) using electronic fetal monitoring (EFM) by applying a systems-level safety framework at two Canadian hospitals that provide perinatal services. The Systems Engineering Initiative for Patient Safety 101 (SEIPS 101) is a framework for modeling components of a healthcare work system, processes and their associated outcomes. This systems-level investigation at OSMH and RVH enabled HIROC human factors specialists in partnership with clinical leaders to identify opportunities to improve safety, and subsequent projects for deeper investigation.
Methods
Two HIROC safety and risk management specialists conducted site visits for four days at OSMH and five days at RVH. The specialists reviewed relevant hospital protocols and procedures, and while on-site, engaged in contextual inquiry, semi-structured interviews and focus groups with 27 and 25 participants, respectively at OSMH and RVH. Participant roles included nurses, midwives, obstetricians and physician assistants to understand current processes, as well as biomed technicians to understand equipment functionality and capabilities. After the site visits were completed, the HIROC specialists analysed the data using the SEIPS 101 framework, specifically using the People-Environments-Tasks-Tools (PETT) tool to identify barriers and facilitators to safe FHS care using EFM.
Results/Learning
The preliminary analysis of the contextual inquiry data, interviews and focus groups revealed several common themes as barriers and facilitators to safe FHS care using EFM. Facilitators included having strong interdisciplinary teamwork and using proper terminology as a standard to describe EFM tracings. Barriers included complex EFM strips that may lead to differing interpretations between healthcare providers. Additionally, unique findings were observed between sites, such as having team members as certified FHS instructors to provide interdisciplinary training and having physician assistants on staff to support both nurses and physicians during perinatal care. These unique findings support the understanding that care and its associated risks are greatly impacted by local context.
Authors
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Patient Safety Research and Initiatives