Maternal Morbidity and Birth Satisfaction After Implementation of a Validated Calculator to Predict Cesarean Delivery During Labor Induction

Hamm, Rebecca F.; McCoy, Jennifer; Oladuja, Amal; Bogner, Hilary R; Elovitz, Michal A.; Morales, Knashawn H.; Srinivas, Sindhu K.; Levine, Lisa D.

doi:10.1001/jamanetworkopen.2020.25582

Cited by 16 publications

(25 citation statements)

References 20 publications

(42 reference statements)

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“…Although the included predictors vary, these models demonstrate similar discrimination (area under the receiver-operating-characteristics curve, 0.73-0.78) and calibration. Implementation of one of these calculators in the setting in which it was developed was found to reduce obstetric morbidity 29 , but concerns were raised that the calculator had much poorer performance when applied to populations from other centers, even those based in the same continent 30 .…”

Section: Discussionmentioning

confidence: 99%

Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials

Quach

Eikelder

Jozwiak

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?We identified key maternal and fetal characteristics that predict the risk of Cesarean section for failure to progress or suspected fetal compromise following induction of labor. The direction and magnitude of these relationships differed depending on the indication for Cesarean section. Bishop score alone is not sufficient to predict the risk of Cesarean section. What are the clinical implications of this work?Identifying appropriate candidates for induction of labor is important in reducing maternal morbidity and making rational use of resources. When assessing the risk of Cesarean section following induction of labor, it is necessary to consider a comprehensive range of maternal and fetal characteristics rather than Bishop score alone.

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Section: Discussionmentioning

confidence: 99%

Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials

Quach

Eikelder

Jozwiak

et al. 2022

Ultrasound in Obstet & Gyne

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“…This is a secondary analysis of a prospective cohort study of women undergoing labor induction at our institution before and after implementation of the cesarean risk calculator into usual clinical care [ 7 ]. Prior to implementation, the cesarean risk calculator was not used on our unit.…”

Section: Methodsmentioning

confidence: 99%

“…Here, we evaluated audit and feedback as an implementation strategy for incorporation of a validated calculator that predicts likelihood of cesarean delivery during labor induction into inpatient obstetric care at one university-based labor unit [ 6 , 7 ]. Like many inpatient care interventions, this calculator was meant to be utilized by clinical teams on a daily basis.…”

Section: Introductionmentioning

confidence: 99%

Daily weekday audit and feedback to clinicians for an inpatient intervention in obstetrics: is there sustained impact over the weekend? A secondary analysis of a prospective cohort study

Hamm

Levine

Lane‐Fall

et al. 2021

Implement Sci Commun

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Background Audit and feedback as an implementation strategy leads to small, but potentially important improvements in practice. Yet, audit and feedback is time and personnel intensive. Many interventions designed for inpatient care are meant to be utilized by care teams all days of the week, including weekends when research staff are at a minimum. We aimed to determine if audit and feedback regarding use of an evidence-based inpatient obstetric intervention performed only on weekdays could have a sustained impact over the weekend. Methods This study was performed as a secondary analysis of a prospective cohort study examining the impact of implementation of a validated calculator that predicts the likelihood of cesarean delivery during labor induction. During the 1 year postimplementation period, Monday through Friday, a member of the study team contacted clinicians daily to provide verbal feedback. While the same clinician pool worked weekend shifts, audit and feedback did not occur on Saturdays or Sundays. The primary outcome was intervention use, defined as documentation of counseling around the cesarean risk calculator result, in the electronic health record. Intervention use was compared between those with (weekdays) and without (weekends) audit and feedback. Results Of the 822 women meeting eligibility criteria during the postimplementation period (July 1, 2018–June 30, 2019), 651 (79.2%) were admitted on weekdays when audit and feedback was occurring and 171 (20.8%) on weekends without audit and feedback. The use of the cesarean risk calculator was recorded in 676 of 822 (82.2%) of eligible patient charts. There was no significant difference in cesarean risk calculator use overall by days when audit and feedback occurred versus days without audit and feedback (weekday admissions 82.0% vs. weekend admissions 83.0%, aOR 0.90 95% CI [0.57–1.40], p = 0.76). There was no significant trend in the relationship between calculator use and weekday versus weekend admission by month across the study period (p = 0.21). Conclusions Daily weekday audit and feedback for implementation of an evidence-based inpatient obstetric intervention had sustained impact over the weekends. This finding may have implications for both research staffing, as well as sustainability efforts. Further research should determine the lowest effective frequency of audit and feedback to produce implementation success.

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“…After development of the cesarean risk calculator, subsequent work by Hamm et al aimed to quantitatively evaluate its implementation into routine care [7]. In a prospective cohort study comparing clinical outcomes before and after cesarean risk calculator implementation, knowledge of a woman's personalized cesarean risk was associated with reduced maternal morbidity and cesarean delivery rates.…”

Section: Introductionmentioning

confidence: 99%

“…Given these findings, the next step is to implement the cesarean risk calculator at diverse sites nationally [9]. Yet, with only quantitative data, we had limited ability to understand clinician perceptions of the cesarean risk calculator, as well as the mechanisms through which the cesarean risk calculator may have impacted outcomes [7]. Thus, in this work, we employed qualitative methods to explore (1) clinicians' perceptions of the cesarean risk calculator, including barriers and facilitators to use, and (2) perceived impact of the cesarean risk calculator on clinician decision-making and the patient-clinician relationship during labor induction.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a calculator to predict cesarean delivery during labor induction: a qualitative evaluation of the clinician perspective

Hamm

Levine

Nelson

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Maternal Morbidity and Birth Satisfaction After Implementation of a Validated Calculator to Predict Cesarean Delivery During Labor Induction

Abstract: This cohort study assesses whether implementation of a validated calculator for likelihood of cesarean delivery at the time of labor induction is associated with maternal morbidity and birth satisfaction.

Cited by 16 publications

References 20 publications

Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials

Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials

Daily weekday audit and feedback to clinicians for an inpatient intervention in obstetrics: is there sustained impact over the weekend? A secondary analysis of a prospective cohort study

Implementation of a calculator to predict cesarean delivery during labor induction: a qualitative evaluation of the clinician perspective

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