(328) Standardizing induction management: a mixed-methods evaluation of the clinician perspective

Objective: Standardizing labor induction (IOL) practices may reduce cesarean and improve obstetric disparities. IOL protocols focus on active management with recommendations for frequent cervical exams, early amniotomy, and intervention when no cervical change is made. Here, we aimed to characterize the clinician perspective on feasibility and acceptability of a standardized IOL protocol.

Study Design: This sequential mixed-methods study surveyed clinicians after implementation of a standardized IOL protocol at 2 sites in 2021. We used the 4-question validated Acceptability of Intervention Measure (AIM; total 4-20) as well as a single acceptability item (1-5) for each of 8 specific protocol components (Table). Total AIM scores were grouped into tertiles. Clinicians in the top (High Acceptability) and bottom (Low Acceptability) tertiles were invited to participate in a semi-structured interview. Topics included (a) acceptability of protocol components, (b) barriers/facilitators to adherence, and (c) strategies for overcoming barriers. Interviews were coded using an integrated approach with high inter-rater reliability (k=0.83).

Results: 104 clinicians (57 physicians, 43 RNs, 4 CNMs) completed the survey. Median total AIM score was 15/20 IQR [12-19]. Protocol components with highest acceptability scores focused on not continuing “futile” cervical ripening and interventions for active labor dystocia. Components with less approval included frequent cervical exams and early amniotomy. 24 clinicians were interviewed (12 High, 12 Low Acceptability). Clinicians described barriers to implementation of less acceptable components, including staff/time constraints, best practice disagreements, and concerns around patient aversion. Clinicians recommended more education around the protocol’s safety/efficacy, and communication about anticipated IOL steps to overcome barriers.

Conclusion: This work describes the clinician perspective on standardizing IOL and provides concrete recommendations to overcome implementation barriers.