Healthcare Educational and Research Fund (on behalf of the Healthcare Association of New York State)

Electronic fetal monitoring (EFM) is the most widely implemented method of intrapartum surveillance; it can be an effective way to warn an obstetric team of potential serious fetal complications that can lead to injury, including brain damage, or death. However, variations in EFM interpretations and poor communication of fetal heart rate (FHR) data limit its effectiveness. In 1997, standard definitions and nomenclature for visually interpreting, documenting, and communicating FHR tracings were created. However, these standards have not been widely adopted, mainly because there is no universal training curriculum for all obstetric disciplines, and hospitals lack resources to change provider practices. In December 2008, NYHealth awarded the Healthcare Educational and Research Fund (HERF), a nonprofit affiliate of the Healthcare Association of New York State (HANYS), a grant to help standardize the method by which obstetric team members interpret, communicate, document, and manage FHR tracings obtained through EFM. The initiative was a joint partnership among HANYS, the American Congress of Obstetricians and Gynecologists, District II/NY (ACOG), and the New York State Department of Health.

Grantee: Healthcare Educational and Research Fund, Inc./ Healthcare Association of New York State

Grant Title: Electronic Fetal Monitoring: Improving Birth Outcomes in New York State

Dates: December 1, 2008 – March 22, 2012

Funding: Special Projects Fund

Grant Amount: $477,710

Grant Goals:

Under this initiative, HERF hoped to accomplish its goal to improve birth outcomes by training obstetric teams to standardize EFM methods through the following activities:

• Conduct six one-and-a-half-day accredited train-the-trainer sessions for multidisciplinary obstetric teams throughout the State. Nationally renowned clinical experts in EFM education served as faculty for the sessions.
• Develop and distribute resources for participants of the train-the-trainer sessions to encourage the ongoing application of these practices in all hospitals with obstetric services.
• Encourage obstetric providers to take the National Certification Corporation’s (NCC) EFM exam through reimbursement of exam costs.

Grant Outcomes:

Through this joint partnership among HANYS, ACOG, and the New York State Department of Health, HERF accomplished the following:

• Trained 392 obstetric providers, including physicians, nurses, and midwives, at six regional train-the-trainer sessions to use a standardized nomenclature for interpreting and communicating EFM. Providers also received manuals and additional resources to educate others in their respective obstetric units.
• Surveyed EFM training participants and determined that the education sessions were effective in improving participants’ EFM knowledge.
• Conducted follow-up Web conferences designed to provide participants with an opportunity to learn from institutions that have already implemented the training, ask focused clinical questions, encourage discussion, and generate a collection of ideas for overcoming barriers.
• Developed a Web-based EFM toolkit, hosted online by ACOG, to keep obstetric providers up to date on the latest evidence-based research and provide them with additional tools to sustain ongoing EFM competency.
• Reimbursed 169 individuals for the cost of the NCC exam; at least 382 providers affiliated with the New York State initiative, including nurses, physicians, and midwives, became EFM-certified during the two-year initiative.
• Surveyed EFM training participants and found that 94% of them implemented one or more practice improvements.
• Surveyed EFM training participants and found that 93% of  them had implemented at least one method to monitor ongoing EFM competency. This demonstrates that hospitals are committed to maintaining EFM competency over time.

Grantee Website: http://www.hanys.org
Grant ID #: 2531737