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Healthcare Provider Perceptions of a Novel Automated Maternal Electronic Surveillance System
Abstract Number: T1B-164
Abstract Type: Original Research
A leading cause of preventable maternal death is related to delayed or inadequate response to clinical warning signs (1). As previously described (2), we developed an FDA-cleared automated electronic surveillance tool, AlertWatch OB (AWOB). This tool was fully implemented in April 2017 and selectively pages labor and delivery nurses to initially evaluate abnormal vital signs before paging clinicians with sustained vital sign abnormalities. To our knowledge, this is the first time computer software has been used on a labor and delivery unit to deliver targeted automated early warning pages to all labor and delivery providers. This survey study evaluates healthcare provider perceptions of this system.
An anonymous online survey was sent to providers on the labor and delivery unit, including labor and delivery nurses (RN), certified nurse midwives (CNM), obstetrics (OB) residents and fellows, anesthesiology trainees as well as OB, family medicine (FM) and anesthesiology faculty on 12/13/18. Survey domains included: perceptions of the system’s effect on patient care, alarm fatigue, and continued use of the system. Survey responses were collected on 1/28/19.
The overall survey response rate was 45% (235/523). RNs (35% of 235 respondents) and OB/FM faculty (19% of respondents) were the most frequent respondents. Respondents agreed or strongly agreed the system improved: response time to severe morbidity (65%), patient safety (65%), communication (59%), management of severe morbidity (50%) and teamwork (42%). Of those who had received a page, 54% felt that they received pages “too frequently” and 45% felt that they received pages “the right amount of the time.” Four respondents agreed or strongly agreed with the statement “I feel that AWOB pages have caused patient harm.” The majority, 83% of respondents, felt that the system should remain in use, but acceptance rates varied. For example, 12/20 (60%) of CNM, 68/83 (82%) of RN, 39/45 (87%) of OB/FM faculty, and 48/55 (87%) of anesthesia provider respondents felt the system should remain in use.
Most respondents felt that the system improved patient safety, communication and response time to severe morbidity. With any automated system, false positive notifications are unavoidable, and alarm fatigue is a concern. Many respondents felt that they received pages too frequently. Despite this, 83% of respondents felt that the system should remain in use on our unit. Response bias, recall bias and limited survey response are important limitations of this study. A large majority of providers on our unit support the continued use of this automated maternal electronic surveillance system. Additional studies are required to determine an objective impact of this system on maternal care and how the system can be improved.
1. Matern Child Health J 2014 Apr;18(3):518-26
2. BMC Anesthesiol. 2018; 18: 78. PMID: 29945569