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Intrapartum electronic fetal monitoring: imperfect technologies and clinical uncertainties—what can a human factors and social science approach add?

Sandall, Jane

BMJ quality & safety, 2024-04, Vol.33 (4), p.220-222 [Periódico revisado por pares]

England: BMJ Publishing Group Ltd

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  • Título:
    Intrapartum electronic fetal monitoring: imperfect technologies and clinical uncertainties—what can a human factors and social science approach add?
  • Autor: Sandall, Jane
  • Assuntos: Cardiotocography ; Childbirth & labor ; Decision making ; Editorial ; Ergonomics ; Ethnography ; Female ; Health care ; Heart ; Human factors ; Humans ; Labor, Obstetric ; Labour ; Legal rights ; Monitoring ; Monitoring, Physiologic ; Obstetrics ; Obstetrics and gynecology ; Patient safety ; Pregnancy ; Research methods ; Safety ; Safety engineering ; Science ; Social Sciences ; Technology ; Womens health
  • É parte de: BMJ quality & safety, 2024-04, Vol.33 (4), p.220-222
  • Notas: SourceType-Other Sources-1
    content type line 63
    ObjectType-Editorial-2
    ObjectType-Commentary-1
  • Descrição: Correspondence to Professor Jane Sandall, King's College London, London WC2R 2LS, UK; jane.sandall@kcl.ac.uk For many women, fetal well-being in labour is assessed using continuous electronic fetal monitoring with cardiotocography (CTG), a technique used to monitor the fetal heartbeat and uterine contractions during pregnancy and labour.1 However, problems in the assessment of fetal well-being in labour and delays in escalation and response have been consistently highlighted in maternity care safety inquiries, both in the UK and internationally, causing untold distress to parents and families.2–6 Taking an interdisciplinary perspective, drawing on both human factors/ergonomics and social science, the study from Lamé and colleagues,7 published in this issue of BMJ Quality and Safety, aims to understand the everyday practice of electronic fetal monitoring with CTG and the organisational and work context within which this takes place. A human factors approach aims to understand how tasks are conducted in practice (work ‘as done’), rather than how they are documented or prescribed (work ‘as imagined’).8 Lamé and colleagues’ analysis was based on the System Engineering Initiative for Patient Safety 2.0 model to describe the work systems, the interactions of people, tasks, technology, organisational structures, environment and external influences on CTG monitoring. [...]a social science theoretical perspective can deepen knowledge of wider social, cultural and political factors, and asks critical questions about the role of social inequality, power and control in the framing and enactment of safety policies and practices.9 For example, this approach has been used to provide insight into problems with the lack of timely recognition, and treatment response of women and patients whose condition is deteriorating while receiving care in acute maternity and medical settings.10 Specifically, ethnography is a research methodology that can show what happens routinely in healthcare, and reveal the what and how of improving patient care.11 By combining these two approaches, the authors highlight how electronic fetal monitoring is not a simple process but a complex sociotechnical activity involving multiple interdependent elements (people, tasks, technology and tools, environment and organisation) that may interact in complex ways. In addition to the above, continuous electronic fetal monitoring promises greater diagnostic certainty, which should inform decision-making on management; however, it is important to note that an underlying issue contributing to delays is that midwives and doctors are limited in their interpretation and decision-making due to uncertainties in the accuracy and validity of CTG measurement,12 even when computerised interpretation is used,13 and that these issues remain problematic in other areas of measurement of patient deterioration in healthcare.14 Social science analyses of medical uncertainty are a substantive area of research in the social sciences and health technologies,15 and further research in this area would be fruitful.
  • Editor: England: BMJ Publishing Group Ltd
  • Idioma: Inglês
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