- Email: [email protected]
AN ALPHANUMERIC PAGING SYSTEM; AN ONGOING QUALITY IMPROVEMENT PROJECT
SOGC MEETING ABSTRACTS
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P-OBS-JM-130 ...........................................................................
INVESTIGATING THE INCREASED INCIDENCE OF SHOULDER DYSTOCIA IN NOVA SCOTIA: A RETROSPECTIVE DATABASE AND CHART REVIEW Emily Gray, Victoria Allen, Balpreet Singh, Irene Gagnon, Rebecca Attenborough, Christy Woolcott Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, Canada, B3H 4R2 Objectives: To determine if variation in the prevalence of risk factors accounts for the increase in shoulder dystocia rates in Nova Scotia, and to estimate the proportion of deliveries recorded with shoulder dystocia that had supporting documentation in the medical chart. Methods: A population-based retrospective cohort study was conducted using the Atlee Perinatal Database including all singleton vaginal cephalic deliveries between 1988 and 2017. Shoulder dystocia rates in five epochs were standardized to the distribution of risk factors observed in the cohort. To address our second objective, charts of 400 randomly selected deliveries coded with shoulder dystocia that occurred in Halifax between 2006 and 2015 were reviewed. Results: Rates of shoulder dystocia as recorded in the Atlee Database were 1.4% in 1988-1992, 2.4% in 1993-1998, 3.4% in 1999-2005, 4.6% in 2006-2010, and 5.2% in 2011-2017. Changes in the distribution of risk factors such as prepregnancy weight, gestational weight gain, and diabetes did not account for the increase over time. Shoulder dystocia was explicitly documented in 95% of the 400 charts reviewed. Few charts (16%) contained documentation of a clinical sign associated with shoulder dystocia but most (90%) contained documentation of a maneuver executed in its management. Of the 81% of charts that noted severity, 69% were described as mild, with the frequency of mild cases increasing over time (p = 0.15). Conclusions: Increased rates of shoulder dystocia do not appear to be a result of increased risk factor prevalence or over-coding. Further research is necessary to improve diagnosis and documentation. Key Words: Shoulder dystocia, documentation
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O-OBS-JM-026 ..........................................................................
AN ALPHANUMERIC PAGING SYSTEM; AN ONGOING QUALITY IMPROVEMENT PROJECT Kate Greeff, Jennifer Mateshaytis, Jonathan Tankel University of Alberta, Lois Hole Hospital for Women, Royal Alexandra Hospital,10240 Kingsway Avenue NW, Edmonton, Alberta, Canada, T5H 3V9 Objectives: The objective of this quality improvement (QI) initiative was to introduce an alphanumeric paging system to streamline communication, enable triaging of responses and improve resident efficiency. The overall goal being an improvement in patient safety. Methods: Pre-intervention Likert format surveys were distributed to OBGYN residents and RNs to evaluate the current paging practices at a tertiary care center. Questions assessed perceptions of efficiency, ability to triage, effectiveness of communication and patient safety. Education sessions were held to review the alphanumeric paging format (location, urgency and context of the page) and the system was implemented. Post-intervention Likert format surveys reassessed perceptions and solicited feedback, which was integrated with ongoing QI cycles. All data was anonymously collected and analyzed via REDcap. Results: Comparison between pre- and post-intervention surveys obtained from the nurses and residents were resoundingly positive with regards to impact on patient care. Survey results from RNs suggest improved efficiency in communication as well as decreased
time taken to respond to patient needs. The introduction of message-based paging showed an improved ability of residents to triage urgent vs. non-urgent pages, reducing interruptions in patient care. Conclusions: Implementation of an alphanumeric paging system achieved the objective of this QI project by streamlining communication between nurses and residents. The improvement in resident efficiency, response time to emergent situations and triaging abilities has led to plans to extend the intervention to attending physicians in the future. The ultimate goal of the QI intervention being an overall improvement in patient safety. Key Words: quality improvement, patient safety, alphanumeric paging
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O-OBS-PE/AD-MD-023 ........................................................
UNSCHEDULED VISITS TO THE OBSTETRICAL TRIAGE ASSESSMENT UNIT BY PREGNANT ADOLESCENTS IN AN URBAN CANADIAN CENTER COMPARED TO A MATCHED COHORT OF ADULT PREGNANT WOMEN. Florence Gregoire-Briard, Nathalie Fleming The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9 Objectives: Obstetrical triage assessment units (OTAU) offer rapid evaluation of pregnancy complications. Objectives of this study were to (1) determine frequency of visits to the OTAU by pregnant adolescent patients, (2) identify main reasons for visit to the OTAU and (3) assess frequency of visits to the OTAU by adolescents compared to a matched cohort of adult pregnant women. Methods: After IRB approval, retrospective chart review was performed of all adolescent women (age ?20) who delivered at our institution between January 1st 2013 and December 31st 2017. Patients were matched in a 1:1 ratio with adult pregnant women (age >20). Demographic data, number and reasons for visits to the OTAU were recorded. Results: 333 adolescent pregnant women were included in the study and 48% (N=160) visited the OTAU prior to delivery (18.6 (+/- 1.07) years). 159 adult women were included in a matched cohort (32.1 (+/- 4.74) years). Mean number of visits to the OTAU during pregnancy was 2.77 (+/-2.40) visits for adolescents and 1.96 (+/- 1.80) visits in the adult cohort (p=0.0002). Risk factors associated with increased number of visits included psychiatric conditions (3.51 visits/patient; p=0.0001), smoking (3.11 visits/patient; p=0.0001), history of preterm labor (4.71 visits/patient; p=0.0001) and multiparity (3.24 visits/patient; p=0.0001). Common reasons for visits by adolescents were: labor assessment (28.4%), vaginal leakage of fluid (19.2%) and preterm labor assesment (7.9%). Conclusions: Adolescent pregnant women tend to visit the OTAU on an unscheduled basis more often than adult patients. Educational material can be developed to meet the needs of this population. Key Words: adolescent pregnancy, antenatal care
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O-GYN-JM-095.........................................................................
LGBTQ2SIA+ HEALTH CURRICULUM IN CANADIAN OBSTETRICS AND GYNAECOLOGY RESIDENCY PROGRAMS Aleah Hazan, Nicole Todd University of British Columbia, Dept of Obstetrics and Gynecology, Room 6253, 6th Floor Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, Canada, V5Z 1M9
MAY JOGC MAI 2019
719
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P-OBS-JM-130 ...........................................................................
INVESTIGATING THE INCREASED INCIDENCE OF SHOULDER DYSTOCIA IN NOVA SCOTIA: A RETROSPECTIVE DATABASE AND CHART REVIEW Emily Gray, Victoria Allen, Balpreet Singh, Irene Gagnon, Rebecca Attenborough, Christy Woolcott Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, Canada, B3H 4R2 Objectives: To determine if variation in the prevalence of risk factors accounts for the increase in shoulder dystocia rates in Nova Scotia, and to estimate the proportion of deliveries recorded with shoulder dystocia that had supporting documentation in the medical chart. Methods: A population-based retrospective cohort study was conducted using the Atlee Perinatal Database including all singleton vaginal cephalic deliveries between 1988 and 2017. Shoulder dystocia rates in five epochs were standardized to the distribution of risk factors observed in the cohort. To address our second objective, charts of 400 randomly selected deliveries coded with shoulder dystocia that occurred in Halifax between 2006 and 2015 were reviewed. Results: Rates of shoulder dystocia as recorded in the Atlee Database were 1.4% in 1988-1992, 2.4% in 1993-1998, 3.4% in 1999-2005, 4.6% in 2006-2010, and 5.2% in 2011-2017. Changes in the distribution of risk factors such as prepregnancy weight, gestational weight gain, and diabetes did not account for the increase over time. Shoulder dystocia was explicitly documented in 95% of the 400 charts reviewed. Few charts (16%) contained documentation of a clinical sign associated with shoulder dystocia but most (90%) contained documentation of a maneuver executed in its management. Of the 81% of charts that noted severity, 69% were described as mild, with the frequency of mild cases increasing over time (p = 0.15). Conclusions: Increased rates of shoulder dystocia do not appear to be a result of increased risk factor prevalence or over-coding. Further research is necessary to improve diagnosis and documentation. Key Words: Shoulder dystocia, documentation
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O-OBS-JM-026 ..........................................................................
AN ALPHANUMERIC PAGING SYSTEM; AN ONGOING QUALITY IMPROVEMENT PROJECT Kate Greeff, Jennifer Mateshaytis, Jonathan Tankel University of Alberta, Lois Hole Hospital for Women, Royal Alexandra Hospital,10240 Kingsway Avenue NW, Edmonton, Alberta, Canada, T5H 3V9 Objectives: The objective of this quality improvement (QI) initiative was to introduce an alphanumeric paging system to streamline communication, enable triaging of responses and improve resident efficiency. The overall goal being an improvement in patient safety. Methods: Pre-intervention Likert format surveys were distributed to OBGYN residents and RNs to evaluate the current paging practices at a tertiary care center. Questions assessed perceptions of efficiency, ability to triage, effectiveness of communication and patient safety. Education sessions were held to review the alphanumeric paging format (location, urgency and context of the page) and the system was implemented. Post-intervention Likert format surveys reassessed perceptions and solicited feedback, which was integrated with ongoing QI cycles. All data was anonymously collected and analyzed via REDcap. Results: Comparison between pre- and post-intervention surveys obtained from the nurses and residents were resoundingly positive with regards to impact on patient care. Survey results from RNs suggest improved efficiency in communication as well as decreased
time taken to respond to patient needs. The introduction of message-based paging showed an improved ability of residents to triage urgent vs. non-urgent pages, reducing interruptions in patient care. Conclusions: Implementation of an alphanumeric paging system achieved the objective of this QI project by streamlining communication between nurses and residents. The improvement in resident efficiency, response time to emergent situations and triaging abilities has led to plans to extend the intervention to attending physicians in the future. The ultimate goal of the QI intervention being an overall improvement in patient safety. Key Words: quality improvement, patient safety, alphanumeric paging
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O-OBS-PE/AD-MD-023 ........................................................
UNSCHEDULED VISITS TO THE OBSTETRICAL TRIAGE ASSESSMENT UNIT BY PREGNANT ADOLESCENTS IN AN URBAN CANADIAN CENTER COMPARED TO A MATCHED COHORT OF ADULT PREGNANT WOMEN. Florence Gregoire-Briard, Nathalie Fleming The Ottawa Hospital, 1053 Carling Ave., Ottawa, Ontario, Canada, K1Y 4E9 Objectives: Obstetrical triage assessment units (OTAU) offer rapid evaluation of pregnancy complications. Objectives of this study were to (1) determine frequency of visits to the OTAU by pregnant adolescent patients, (2) identify main reasons for visit to the OTAU and (3) assess frequency of visits to the OTAU by adolescents compared to a matched cohort of adult pregnant women. Methods: After IRB approval, retrospective chart review was performed of all adolescent women (age ?20) who delivered at our institution between January 1st 2013 and December 31st 2017. Patients were matched in a 1:1 ratio with adult pregnant women (age >20). Demographic data, number and reasons for visits to the OTAU were recorded. Results: 333 adolescent pregnant women were included in the study and 48% (N=160) visited the OTAU prior to delivery (18.6 (+/- 1.07) years). 159 adult women were included in a matched cohort (32.1 (+/- 4.74) years). Mean number of visits to the OTAU during pregnancy was 2.77 (+/-2.40) visits for adolescents and 1.96 (+/- 1.80) visits in the adult cohort (p=0.0002). Risk factors associated with increased number of visits included psychiatric conditions (3.51 visits/patient; p=0.0001), smoking (3.11 visits/patient; p=0.0001), history of preterm labor (4.71 visits/patient; p=0.0001) and multiparity (3.24 visits/patient; p=0.0001). Common reasons for visits by adolescents were: labor assessment (28.4%), vaginal leakage of fluid (19.2%) and preterm labor assesment (7.9%). Conclusions: Adolescent pregnant women tend to visit the OTAU on an unscheduled basis more often than adult patients. Educational material can be developed to meet the needs of this population. Key Words: adolescent pregnancy, antenatal care
&
O-GYN-JM-095.........................................................................
LGBTQ2SIA+ HEALTH CURRICULUM IN CANADIAN OBSTETRICS AND GYNAECOLOGY RESIDENCY PROGRAMS Aleah Hazan, Nicole Todd University of British Columbia, Dept of Obstetrics and Gynecology, Room 6253, 6th Floor Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, Canada, V5Z 1M9
MAY JOGC MAI 2019
719