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CMAJ • September 3, 2002; 167 (5)
© 2002 Canadian Medical Association or its licensors

Research
Recherche

Fetal health surveillance: a community-wide approach versus a tailored intervention for the implementation of clinical practice guidelines

Barbara Davies*, Ellen Hodnett{ddagger}, Mary Hannah§, Linda O'Brien-Pallas{ddagger}, Dorothy Pringle{ddagger}, George Wells{dagger}, members of the Perinatal Partnership Program of Eastern and Southeastern Ontario and the Society of Obstetricians and Gynaecologists of Canada**

From *the School of Nursing and {dagger}the Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.; {ddagger}the Faculty of Nursing, University of Toronto, Toronto, Ont.; and §the Department of Obstetrics and Gynaecology, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Ont. ¶Members: Marie-Josée Trépanier, Patricia Niday, Carl Nimrod, Ann Sprague, **Member: André Lalonde

Correspondence to: Dr. Barbara L. Davies, Faculty of Health Sciences, University of Ottawa, 451 Smyth Rd., Ottawa ON K1H 8M5; fax 613 562-5443

Background: The decreased use of electronic fetal monitoring (EFM) for healthy women in labour and the increased provision of professional support to all women in labour is recommended by experts. We evaluated the effectiveness of a community-wide approach to transferring research results to practice using a regional committee, newsletter articles and annual conference presentations compared with an additional tailored hospital intervention involving workshops to enhance self-efficacy for nurses, policy review, multidisciplinary meetings, rounds and unit discussions.

Methods: We compared the proportion of women at low risk who received EFM and the proportion of nurses' time spent providing labour support before and after the intervention within each of 4 hospitals (2 tertiary and 2 secondary). One hospital of either type was randomly selected to receive the tailored intervention. Randomly selected charts (n = 200) were reviewed for the use of EFM at each hospital before (1995) and after (1996) the intervention. Trained observers at randomly selected times recorded the nurses' activities, including time spent providing labour support before and after the intervention.

Results: >At the intervention secondary hospital, there was a large decrease in the use of EFM, from 90.1% before to 41.0% after the intervention (p < 0.001), but no change in nurses' time spent providing labour support. At the intervention tertiary hospital there was no change in EFM rates, but there was a small, statistically significant increase in time spent providing labour support (23.5% to 29.8%, p < 0.001). A negative effect on time spent providing labour support was found at the control secondary hospital (decrease from 19.6% to 12.8%, p < 0.001), with no change in the EFM rate. At the control tertiary hospital there was a small decrease in the use of EFM, from 99.5% to 91.4% (p < 0.001), but no change in time spent providing labour support.

Interpretation: The results are mixed, and the tailored intervention thus appeared to have limited effects. No association was found between the reduction in the use of EFM and an increase in nurses' time spent providing labour support.