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Driving Toward Improved Outcomes

UH developing easy-to-read “dashboard” to better manage labor and delivery

UH Innovations in Pediatrics - December 2017
Special Innovators Issue


Chief, System Quality for Obstetrics, University Hospitals; Assistant Professor of Obstetrics & Gynecology, Case Western Reserve University School of Medicine

Modern management of labor and delivery can sometimes make it difficult for clinicians to achieve optimal situational awareness for each patient.

“Unlike in the past, labor today is generally managed by teams that change, perhaps every 12 hours or every 24 hours,” says Nancy Cossler, MD, Chief of System Quality for Obstetrics at University Hospitals. “You’re also not as likely to be delivered by the person from whom you received prenatal care.”

Add to this the voluminous amounts of data generated and presented to clinicians in the electronic medical record (EMR) – data that can be difficult to digest and synthesize.

To overcome these obstacles to situational awareness, a team at UH is developing software to support clinical decision-making in labor and delivery. The software provides valuable information on fetal and maternal health in an easy-to-use “dashboard” format -- not buried in the abundance of captured data in the EMR. The project was selected for support at UH Rainbow Babies & Children’s Hospital’s Belcher-Weir Family Pediatric Innovation Day, sponsored by UH Rainbow’s Office of Innovation, which led to development of the tool. Clinical decision making software tool

“It condenses 48 hours – the blood pressure, the temperature, the fetal heart rate – with colors and symbols that make it visually quick to appreciate what’s going on,” Dr. Cossler says. That’s really what the tool is meant for. It is the events that get you to the point of delivery that are the most important. These are really the key to good outcomes.”

The software is designed to highlight when low-risk labor has become high-risk labor and highlight sentinel events. Consider the example of prolonged fetal heart rate decelerations, Dr. Cossler says.

”Two prolonged decelerations in any one labor is a trigger for us,” she says. “A trigger means caution. It means I need to get the team together, review the patient’s labor course, make sure that we’re going in the right direction or make a different management decision. Two prolonged decelerations can be 12 hours apart – one might have occurred on the shift before I got there. How can I possibly go back through hours and hours and hours of tracing to make sure that I know – or count on you when you’re giving me sign-out – to know that there was one prolonged deceleration? One prolonged deceleration is not a trigger. Why would you mention it – except that it might be important. With the software and the dashboard we’re developing, these events will be clearly seen. They’ll also facilitate communication during shift change or other care transitions.”

Dr. Cossler and UH nurse Jeff Beers, RN, are working with a software developer to build the prototype for the new decision-making tool. They’ve also received a grant from Ohio’s Third Frontier project, which provides financial support to early-stage technology companies. UH also intends to create a company to commercialize the tool and make it widely available.

For Dr. Cossler, this can’t come soon enough.

“I don’t know why it hasn’t been invented yet, but it hasn’t,” she says. “But I think it’s going to help moms and babies. I hope the impact will be significant in terms of improving outcomes in the management of labor.”


For more information on this project, email