How to Implement Virtual Monitoring in Labor and Delivery

OSF HealthCare is conducting continuous virtual monitoring of moms and fetuses from the beginning of labor through delivery.

OSF HealthCare has launched an initiative to improve monitoring of labor and delivery in the hospital setting.

CMOs and other clinical leaders should be focused on improving maternal morbidity and mortality. The United States has the highest maternal mortality rate compared to other developed countries, with 22 maternal deaths for every 100,000 live births in 2022, according to The Commonwealth Fund.

OSF HealthCare launched its Virtual Labor and Delivery Monitoring program this month. The health system saw a pressing need to improve monitoring in labor and delivery, according to Kate Johnson, BSN, manager of Digital Care-Women's Service at OSF OnCall.

"Maternal and fetal care at OSF HealthCare is increasingly complex and high risk," Johnson says. "So, to provide high quality maternal and fetal care, the health system invested in this program to support the bedside care team, improve patient safety, and strengthen outcomes."

Kate Johnson, BSN, is manager of Digital Care-Women's Services at OSF OnCall. Photo courtesy of OSF HealthCare.

The new program uses a color-coded alert system, enabled by artificial intelligence, to signal early signs of potential complications.

"When an alert is triggered, an OnCall Acute OB team nurse coordinates directly with the hospital care team to ensure prompt follow-up," Johnson says. "The monitoring system uses artificial intelligence to analyze the fetal heart tracings based on definitions from the American College of Obstetricians and Gynecologists, which sets national standards for obstetrics care."

The monitoring program's AI tool is integrated into OSF HealthCare's Epic electronic medical record.

"The EMR feeds information into the AI, including fetal monitoring data such as the baby's heart rate and the mom's vital signs such as pulse and blood pressure," Johnson says. "The AI takes the mom's history into account, including whether she has had babies before and whether she is on Pitocin to help labor progress. The AI looks at all of those data points and color codes any risks."

The AI tool monitors moms and their fetuses constantly from the beginning of labor through delivery. Previously, a bedside nurse would typically get a report every 12 hours and only get highlights of fetal monitor tracing, Johnson explains.

For the fetus, electronic fetal monitoring helps detect early signs of distress such as reduced oxygen supply, abnormal heart rate patterns, umbilical cord compression, and fetal acidemia.

For the mom, electronic monitoring watches vital signs, the contraction pattern, and labor progress to identify concerns such as excessive bleeding, infection, high blood pressure, and complications related to anesthesia.

The nurses who staff the OnCall Acute OB team only intervene when necessary, according to Johnson.

"When the color coding indicates there should be interventions at the bedside, we look for whether those interventions have been charted," Johnson says. "If the interventions have been charted, we do not act because the labor nurse is doing what they have been trained to do. If we see concerning patterns continue after interventions have been made, we contact the bedside nurse and talk through any interventions that may not have been tried."

Johnson says OSF HealthCare hopes the Virtual Labor and Delivery Monitoring program will drive several improvements in clinical outcomes, including reduced rates of severe maternal morbidity, fewer unexpected complications in full-term babies, decreased neonatal ICU admissions, and lower rates of newborn resuscitations.