Poster Session 2
Category: Labor
Poster Session 2
Rebecca F. Hamm, MD, MSCE (she/her/hers)
Assistant Professor, Maternal Fetal Medicine
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Matthew K. Hoffman, MD, MPH
Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology at Christiana Care
Christiana Care Health System
Newark, Delaware, United States
.jpg "Brett D. Einerson, MD, MPH (he/him/his) photo")
Brett D. Einerson, MD, MPH (he/him/his)
Associate Professor, Director of The Utah Placenta Accreta Program
Department of Obstetrics and Gynecology, University of Utah Health
Salt Lake City, Utah, United States
Anthony C. Sciscione, DO
Program Director
Christiana Care Health System
Newark, Delaware, United States
Robert M. Silver, MD
Department of Obstetrics and Gynecology, University of Utah Health
Salt Lake City, Utah, United States
Miriam J. Alvarez, PhD
Research Scientist
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
Alison G. G. Cahill, MD, MSCI
Assoc. Dean, Translational Research; Prof, Women’s Health; Dir, Health Transformation Research Inst.
Department of Women’s Health, Dell Medical School at the University of Texas at Austin
Department of Women’s Health, Dell Medical School at the University of Texas at Austin, Texas, United States
.jpg "Lisa D. Levine, MD, MSCE (she/her/hers) photo")
Lisa D. Levine, MD, MSCE (she/her/hers)
Associate Professor, Chair, Division of MFM.
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
This sequential mixed-methods study (quan- >QUAL; 12/2022-1/2025) was embedded into an ongoing 5-site randomized clinical trial comparing outpatient versus inpatient cervical ripening. Prior to trial initiation, surveys (quan) were distributed to obstetric clinicians at all sites. The survey collected demographics, Foley placement experience, perceived acceptability and feasibility of outpatient Foley via validated measures [Likert; total 4-20]. One year into the trial, clinician focus groups (QUAL) assessed barriers, facilitators, and sustainability of outpatient Foley, guided by the Consolidated Framework for Implementation Research 2.0 and coded by 2 independent coders.
Results:
396 clinicians (64% physicians, 22% nurses, 10% CNMs, 4% NPs/PAs) completed the pre-trial survey; 29.2% had previously used outpatient ripening. Acceptability (19/20 IQR[16-20]) and feasibility (16/20 IQR[15-20]) were high overall but varied by site (p=0.003; p=0.006). Predictors of acceptability and feasibility included female gender and physician/CNM role. As a result, focus groups were divided by site and role to elicit site-specific barriers and facilitate open discussion among nurses without physicians/CNMs present. Twelve focus groups (n=33) identified facilitators including belief in the evidence/safety and benefit, as well as leadership support. Barriers included concerns about timely hospital return, perceived patient discomfort, and operational constraints (e.g. space and staffing). In response, participants discussed systematic strategies to promote sustainability, several already enacted, such as standardized patient education and workflow solutions (Table).
Conclusion:
This work identified key determinants influencing implementation of outpatient cervical ripening with a Foley catheter during a multi-site trial. Findings can inform strategies for future study and to drive success for sites implementing outpatient Foley clinically.