Evaluating the Effect of an Online, Assessment-Driven Learning Platform for Obstetric Providers and Nurses

Abstract

Maternal mortality rate/ratio (MMR) is a significant indicator of the overall quality of health care. While MMR is declining globally, the United States is one of only eight countries where MMR continues to rise. Sadly, many of the issues contributing to MMR, such as delay in diagnosis or treatment, and failure to recognize patients at risk, are preventable. Deficits in staff knowledge or training are common causative factors in preventable maternal deaths. Simulation, e-learning, and instructor-led courses have been implemented globally in an effort to address preventable factors. The Model for Improvement dictates the need for outcome evaluation to determine if a change is an improvement. The purpose of this doctoral project was to evaluate perinatal outcomes following the inclusion of an assessment-driven, individualized e-learning platform focused on obstetric emergencies within a blended learning environment. The Kirkpatrick Model for training evaluation provided a structure for this performance improvement project. Sources for perinatal patient outcome data were identified. Pre- and post-implementation data were charted. Improvements in perinatal outcomes with reduction in maternal morbidity were noted following implementation of the e-learning platform for obstetric emergencies. A slight decrease in overall obstetrical hemorrhage rates was noted (average 54.7/1,000 deliveries down from 56.4/1,000 deliveries at baseline). A slight decrease in massive transfusion rates (4 units pRBC) was realized (average 2.2/1,000 deliveries down from 2.4/1,000 deliveries at baseline). Three consecutive months at the end of the performance period noted 0 cases of massive transfusion indicating improved management of obstetrical hemorrhage. The most significant improvement was with a downward shift in maternal intensive care unit (ICU) admission (average 1.5/1,000 deliveries down from 2.9/1,000 deliveries). Zero ICU admits were noted 6 of the last 7 months of the performance period. Tracking clinical outcomes validated the effectiveness of the e-learning program within a blended learning environment. Data-driven education reduced waste by right-sizing the training for providers and nurses. The intentional focus on closing gaps in knowledge and training in obstetric emergencies for nurses and providers may help reduce maternal morbidity and mortality moving forward. Keywords: e-learning, Kirkpatrick Model, maternal morbidity, maternal mortality, Model for Improvement, obstetric, perinatal outcomes, obstetric hemorrhage