Improving Implementation of Cardio - Obstetric Intrapartum Recommendations Through Provider - Centered Workflow Redesign

Background: The University of Michigan Cardio-Obstetrics team is a multidisciplinary group that includes specialists in Cardiology, Maternal-Fetal-Medicine, Anesthesia, and Nursing caringfor pregnant patients with cardiovascular disease. They provide coordinated, evidence-based care across the preconception, pregnancy, and postpartum periods, with a focus on optimizing maternal and fetal outcomes through individualized management plans.Intrapartum and postpartum care plans are developed prenatally, documented in the electronic health record (EHR), and implemented by inpatient teams including generalist obstetric attending physicians and certified nurse-midwife laborists. A recent retrospective chart review demonstrated that over 30%of patients experienced deviations from Cardio-Obstetrics’documented care plans, potentially increasing maternal and neonatal morbidity.

Objective: To identify barriers to implementation of Cardio-Obstetrics intrapartum recommendations and develop strategies to improve accessibility, interpretation, and adherence among labor and delivery providers.

Methods: This IRB-exempt (HUM00290925) quality improvement project used qualitative focus groups to assess inpatient team members’ attitudes, confidence, and perceived barriers related to accessing and applying Cardio-Obstetric recommendations.Two focus groups(3-4participants each) were conducted via Zoom and explored current dissemination practices, barriers to implementation, and opportunities for workflow improvement. Discussions were recorded, transcribed, and analyzed using thematic analysis to identify recurrent challenges and actionable solutions. Participants also completed pre-and post-intervention surveys.ResultsPreliminary findings identified key barriers and potential solutions. Providers reported greater comfort with clearly structured, comprehensive care plans and reduced confidence when recommendations were incomplete or difficult to interpret. Additional themes included challenges in intrapartum and postpartum fluid management and a desire for a centralized resource organizing recommendations by pathophysiology with accompanying clinical rationale.Overall, the presence of a Cardio-Obstetrics care plan increased provider confidence in caring for high-risk patients. Participants emphasized the need for standardized, centralized, and easily interpretable recommendations integrated into clinical workflows.Post-intervention surveys demonstrated improved satisfaction with accessibility of recommendations, with positive responses increasing from 60% pre-intervention to 100% post-intervention. Provider comfort in managing laboring and postpartum patients with cardiac disease also improved, with positive responses rising from 43% to 80%.Proposed workflow redesign strategies included streamlined documentation templates with clear timestamps, enhanced visibility within the EHR, and improved team-based communication tools.

Conclusions: Implementation gaps in Cardio-Obstetric intrapartum recommendations are possibly driven by system-level barriers in dissemination and usability. Provider-informed workflow redesign represents a feasible strategy to improve access, interpretation, and adherence. Future work will evaluate the impact of these interventions on clinical outcomes, including adherence rates and cesarean delivery rates.