(1066) Improving Intrapartum Vital Sign Charting via a EHR-Embedded Decision Support Tool

Accurate and timely documentation of maternal vital signs during labor is essential for early detection of intrapartum diagnoses, including treatable hypertension and infection. We evaluated whether riskLD, an electronic health record (EHR)-embedded clinical decision support tool issuing real-time alerts, improved compliance with prompt vital sign documentation.

Study Design:

This is a pre-post cohort study of patients admitted for delivery over a 24-month period. Scheduled cesareans were excluded. The primary outcome was compliance with vital sign documentation, defined as ≥ 90% of vital signs documented per 4-hour period prior to rupture of membranes (ROM) and per 2-hour period following ROM. The secondary outcome was percent compliance with each specific vital sign documentation. Outcomes were compared between the pre-implementation cohort (3/1/23-1/31/24) and post-implementation cohort (2/1/24-2/28/25) using bivariate statistical tests and multivariable logistic regression. All results were stratified by compliance pre-ROM and post-ROM.

Results:

3123 patients were in the pre-implementation cohort and 3820 were in the post-implementation cohort. Vital sign charting compliance was higher in the post-implementation cohort both pre-ROM (13.6% vs 11.6%, aOR 1.17 [1.02-1.36]) and post-ROM (57.2% vs 51.7%, aOR 1.24 [1.12-1.37]), Table 1. This difference was largely driven by improvements in maternal temperature documentation pre- and post-ROM, Table 2.

Conclusion:

Implementation of EHR-based alerts with vital sign reminders increased compliance with vital sign documentation, highlighting the potential value of clinical decision-support tools in optimizing labor and delivery care.