Special Projects Fund

Grantee Name

Healthcare Educational and Research Fund, Inc./ Healthcare Association of New York State

Funding Area

Special Projects Fund

Publication Date

December 2012

Grant Amount


Grant Date:

December 1, 2008 – March 22, 2012

Electronic fetal monitoring (EFM) is the most widely implemented method of intrapartum surveillance; it can be an effective way to warn an obstetric team of potential serious fetal complications that can lead to injury, including brain damage, or death.

However, variations in EFM interpretations and poor communication of fetal heart rate (FHR) data limit its effectiveness. In 1997, standard definitions and nomenclature for visually interpreting, documenting, and communicating FHR tracings were created. However, these standards have not been widely adopted, mainly because there is no universal training curriculum for all obstetric disciplines, and hospitals lack resources to change provider practices.

In December 2008, NYHealth awarded the Healthcare Educational and Research Fund (HERF), a nonprofit affiliate of the Healthcare Association of New York State (HANYS), a grant to help standardize the method by which obstetric team members interpret, communicate, document, and manage FHR tracings obtained through EFM. The initiative was a joint partnership among HANYS, the American Congress of Obstetricians and Gynecologists, District II/NY (ACOG), and the New York State Department of Health.

Outcomes and Lessons Learned

  • Trained 392 obstetric providers, including physicians, nurses, and midwives, at six regional train-the-trainer sessions to use a standardized nomenclature for interpreting and communicating EFM. Providers also received manuals and additional resources to educate others in their respective obstetric units.
  • Surveyed EFM training participants and determined that the education sessions were effective in improving participants’ EFM knowledge;
  • Conducted follow-up Web conferences designed to provide participants with an opportunity to learn from institutions that have already implemented the training, ask focused clinical questions, encourage discussion, and generate a collection of ideas for overcoming barriers;
  • Developed a Web-based EFM toolkit, hosted online by ACOG, to keep obstetric providers up to date on the latest evidence-based research and provide them with additional tools to sustain ongoing EFM competency;
  • Reimbursed 169 individuals for the cost of the NCC exam; at least 382 providers affiliated with the New York State initiative, including nurses, physicians, and midwives, became EFM-certified during the two-year initiative;
  • Surveyed EFM training participants and found that 94% of them implemented one or more practice improvements; and
  • Surveyed EFM training participants and found that 93% of  them had implemented at least one method to monitor ongoing EFM competency. This demonstrates that hospitals are committed to maintaining EFM competency over time.