Focus on OB Health and Risk by Using Data to Improve Fetal Monitoring

The Simulation Training & Education Lab (SiTEL) is the education technology group of MedStar Health, a 10-hospital $4.5B not-for-profit healthcare company serving the Baltimore and Washington, D.C. areas. SiTEL’s mission is to transform educational approaches in healthcare by developing training technologies and educational approaches that are user friendly and easily accessible. MedStar’s innovative learning solutions are focused on a simple concept: to improve patient care by reducing risk and using an adaptable learning infrastructure. MedStar SiTEL seeks to create “right-sized learning”—online modules comprised of easily-digestible content that sticks, focuses on outcomes, and makes learning accessible. Staff become engaged by the use of high-production media, relevant stories, opportunities for clinical decision-making, and performance support tools ensuring that learners have access to what they need, when they need it. Right-sized learning is the new world of reasonably-sized content that is often delivered online and via social media in short segments.

The Electronic Fetal Monitoring (EFM) Series

Strengthening EFM competency is vital in improving obstetrics care quality and reducing risk. The EFM courseware series is concise, yet designed to ensure maximum knowledge acquisition and retention, as well as clinical reasoning assessment, through the creative use of virtual simulation. It has been developed to engage learners quickly—allowing each learner to experience real-life situations, make realistic decisions, and experience the outcomes of those decisions.

The EFM modules are comprised of:

A Standardized EFM Knowledge Pre-Assessment

Module 1 – Introduction to EFM terminology

This module covers the terminology related to EFM. Consistent use of this terminology is necessary in the assessment of fetal oxygenation and recognition of fetal hypoxic state. EFM evaluation enables providers to understand and implement the steps necessary to prevent potential harm or neurologic injury to the fetus. At the completion of the module the participant will be able to discuss the elements of uterine activity assessment, describe the components of fetal heart rate patterns, and explain the correlation between fetal heart rate patterns and fetal acidemia.

Module 2 – EFM Beginner

This module covers the three-tiered classification system related to the recognition of ongoing fetal status developed by the National Institute of Child Health and Human Development (NICHD) in April 2008 in partnership with The American Congress of Obstetricians and Gynecologists (ACOG), the Association of Women’s Health, obstetric and neonatal nurses and the Society for Maternal Fetal Medicine. The most effective way for the perinatal team to communicate about the fetal tracing is for all providers to utilize the standardized classification system recommended in the NICHD guidelines. 

At the completion of the module the participant will be able to define the categories of fetal heart tracings, state the components of Category I, Category II and Category III fetal heart tracings, and identify clinical factors affecting the fetal heart tracing.

Module 3 – EFM Intermediate

This module addresses the appropriate treatment of the fetus and mother based upon fetal heart tracing interpretations. Knowing what to do with a particular fetal heart tracing is critical to the clinical outcome. At the completion of the module the participant will be able to interpret fetal heart tracings, recognize the physiologic factors which play a role in fetal heart tracing, describe the components of intra-utero fetal resuscitation, and demonstrate appropriate communication techniques when responding to a concerning fetal heart tracing. 

Module 4 – EFM Advanced

This module addresses the differentiation between Categories II and III fetal heart tracings and the perinatal teamwork and communication needed for the appropriate treatment of the patient, including the escalation of care, when required.

At the completion of the module the participants will be able to describe the differences between Categories II and III fetal heart tracings, demonstrate appropriate communication techniques regarding Category III tracings, and identify when it is necessary to escalate care in response to fetal heart tracings.

An additional learning tool also available is a related, immersive EFM interpretation game. This serious game enables learners to be evaluated on their interpretation and decision making in the simulated setting of a labor and delivery unit. It is an optional component that integrates with the product’s mandatory micro-simulations. The educational methodology around virtual simulation/ gaming has been found to be as effective for use as a high fidelity simulation lab.

Data Analytics in the OB Risk Control Center

Data analytics is a vital component of the product. For example, a clinical leader, leveraging HealthStream’s control center technology, is able to view the data in a meaningful way to determine learning performance and identify risk or need for remediation.

Comparison data becomes particularly valuable in answering and documenting how staff performed on the standardized knowledge exam, the individual course tests, and the micro-simulations. These comparisons will provide valuable insight into not only how knowledgeable the staff is, but also how well they apply the knowledge they have gained.

Along with providing key data and information about a provider’s clinical workforce performance in an individual facility, performance will also be compared to a variety of national benchmarks given the size and scope of the HealthStream national network. Clinical leaders across the country have expressed the need to have greater context around their learning outcomes in this area, wanting as much information as possible about how their organization compares to all others across the United States. HealthStream’s extensive client database allows those “contextual comparisons” to be made.

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April 1, 2021

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