title: Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women.
abstract: BACKGROUND
  Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings.
  
  
  METHODS
  A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session.
  
  
  RESULTS
  Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60-0.95, p = 0.016).
  
  
  CONCLUSIONS
  The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women.
authors.affiliation: Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Newtown, PO Box 7625, Wellington, New Zealand. Robyn.Maude@vuw.ac.nz.
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Maude
authors.forename: Joan P
authors.initials: JP
authors.lastname: Skinner
authors.forename: Maralyn J
authors.initials: MJ
authors.lastname: Foureur
mesh_terms: D001291:Attitude of Health Personnel; D015148:Cardiotocography / Q000706:statistics & numerical data*; D003657:Decision Making; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D019983:Guideline Adherence; D006326:Heart Auscultation / Q000379:methods / Q000706:statistics & numerical data*; D006340:Heart Rate, Fetal; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery / Q000193:education*; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D015397:Program Evaluation; D012307:Risk Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*