title: Changing Labor and Delivery Practice: Focus on Achieving Practice and Documentation Standardization with the Goal of Improving Neonatal Outcomes.
abstract: OBJECTIVE
  To establish multifactorial shoulder dystocia response and management protocol to promote sustainable practice change.
  
  
  METHODS
  Primary data collection was conducted over 3 years. Implementation of the protocol spanned 13 months. Data collection occurred at five sites, which were chosen for their diversity in both patient mix and geographical location.
  
  
  METHODS
  Case study evaluation methodology was used to examine clinician engagement and protocol adoption.
  
  
  METHODS
  The training completion for all practice engagement team activities was collected by the site project manager and entered into a flat file. Data from the labor and delivery notes, medical records, and interviews with labor and delivery teams were gathered and analyzed by the senior investigator.
  
  
  RESULTS
  In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements and in subsequent years, 98 percent completed the follow-up training. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
  
  
  CONCLUSIONS
  System and site management teams implemented a standardized shoulder dystocia protocol that fostered effective teamwork and obstetric team readiness for managing shoulder dystocia emergencies.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia St. Mary's, Milwaukee, WI.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Burstein
authors.affiliation: Department of Obstetrics and Gynecology, St. John Hospital & Medical Center, Detroit, MI.
authors.forename: David M
authors.initials: DM
authors.lastname: Zalenski
authors.affiliation: Department of Obstetrics and Gynecology, St. Vincent's Birmingham, Birmingham, AL.
authors.forename: John L
authors.initials: JL
authors.lastname: Edwards
authors.affiliation: Department of Obstetrics and Gynecology, Saint Agnes Hospital, Baltimore, MD.
authors.forename: Ishrat Z
authors.initials: IZ
authors.lastname: Rafi
authors.affiliation: Care Excellence Department, Ascension Health, St. Louis, MO.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Darden
authors.affiliation: Meyers Primary Care Institute, University of MassachusettsMedical School, Worcester, MA.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Firneno
authors.affiliation: Institute on Healthcare Systems, Brandeis University, Waltham, MA.
authors.forename: Palmira
authors.initials: P
authors.lastname: Santos
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards*; D004282:Documentation / Q000379:methods / Q000592:standards*; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009937:Organizational Objectives; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D058996:Quality Improvement / Q000458:organization & administration
keywords: Shoulder dystocia; adherence; guidelines