The sequential effect of computerized delivery charting and simulation training on shoulder dystocia documentation

Objective. To estimate the effects of computerized charting and shoulder dystocia (SD) simulation drills on the documentation of SD. Methods. 180 cases of SD were evaluated in three consecutive time periods: T1: 45 written delivery notes; T2: 48 delivery notes after the implementation of a standardized SD note in the computerized medical record; T3: 87 computerized delivery notes after SD simulation drills. Results. A standardized SD computerized note resulted in a significant improvement in documentation of EFW, diabetic status, time of the body delivery, fetal head position, which shoulder was impacted, anesthesia, the length of each stage of labor, NICU admission, the birth weight, and that a discussion took place with the patient. The implementation of a SD simulation drill was associated with a further increase in the documentation of the instruments used for delivery, whether a cord pH was performed, and that a discussion took place with the patient. Additionally, the implementation of a SD simulation drill increased the rate of documented SD (1.61% vs. 2.37% of vaginal deliveries, p = 0.0275) and the number of obstetricians who documented a SD (32.35% vs. 60.29% of delivering obstetricians, p = 0.0020). Conclusions. Standardized SD notes as well as simulation drills improve documentation of SD events.