Measuring compliance with a maternal fetal medicine obesity protocol: a secondary analysis

Background: Current trends in patient safety include protocolization of care with assumed compliance to the protocol by health care providers. In 2016, Schuster et al. found that implementation of a protocol for management of obese pregnant patients that included delivery by estimated due date (EDD) actually resulted in a decrease in cesarean deliveries. Although compliance to the aspect of the protocol that affected the primary outcome of that study was evaluated, compliance to every aspect of the protocol was not analyzed. Recent studies have suggested improvements in protocol outcomes when compliance is measured. Therefore, we sought to evaluate compliance to the other aspects of the Geisinger Maternal Fetal Medicine obesity protocol (MOP). Objective: The objective of this study was to identify compliance with all elements of the Geisinger MOP and identify areas for potential improvement with regards to compliance. Study design: We performed a secondary analysis of the original study to evaluate compliance with protocol aspects during the study period. Ninety-seven patients were randomly selected for chart review. We assessed compliance with each element of the protocol, including early diabetes screening, fetal monitoring, growth ultrasounds, and delivery by EDD using simple statistics. Results: By obesity class, compliance was as follows: for class I obese patients, compliance with early diabetes screening was 30% (12/36 patients). For class II obese patients, compliance with early diabetes screening was 57.1% (12/21 patients), and compliance with serial growth ultrasounds was 85.7% (18/21 patients). For class III obese patients, compliance with early diabetes screening was 74.4% (29/39 patients), compliance with serial growth ultrasounds was 84.6% (33/39 patients), compliance with nonstress tests was 82.0% (32/39 patients). Compliance with the recommendation for delivery by estimated due date was 95% (37/39 class III obese patients). Conclusion: Although compliance was excellent with delivery by EDD, compliance with remaining recommendations was low. This suggests additional interventions are important to maintain compliance.