Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes
研究建立并实施肩难产应对管理方案，通过标准化实践和文档，在三年内使报告率提升三倍，团队采纳率达99%，对产科临床管理和培训有参考价值。
OBJECTIVE: To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. DATA SOURCES/STUDY SETTING: Primary data collection was conducted over 3 years. Implementation of the protocol spanned 13 months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location. STUDY DESIGN: Case study evaluation methodology was used to examine clinician engagement and protocol adoption. DATA COLLECTION METHODS: The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file. Data from the labor and delivery notes, medical records, and interviews with labor and delivery teams were gathered and analyzed by the senior investigator. PRINCIPAL FINDINGS: In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements and in subsequent years, 98 percent completed the follow-up training. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol. CONCLUSIONS: System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.