Mahmood Tara*, Mashad University of Medical Sciences, Mashad, Iran, Islamic Republic Of Fatemeh Tara, Mashad University of Medical Sciences, Mashad, Iran, Islamic Republic Of Track: Research Presentation Topic: other Presentation Type: Oral presentation Submission Type: Single Presentation Building: Mermaid Room: Room 3 - Upper River Room Date: 2013-09-24 04:00 PM – 04:45 PM Last modified: 2013-09-25

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Background: Iran is one of the countries with high ratio of Cesarean sections against normal labor. One main reason has been found to be the early non-informed decisions regarding the choice of labor by GORs (gynecology-obstetrics residents). In OUWH (Om-ol-Banin University Women Hospital), the biggest women hospital in East Iran, obstetrical emergencies are primarily managed by GORs, who are in turn directly supervised in the standard day shift by GOSs (gynecology-obstetrics specialists). In the rest of 24 hours, GORs call on-call GOSs when needed. A main drawback to phone call medical consultation, especially in obstetrical emergency cases, is unavailability of vital information such as cardiotocographs (CTGs) to GOSs for an informed decision regarding the right choice of labor method. In this study, we designed and implemented a stepwise teleconsulting system that eventually upgraded phone-based consultation by including enhanced cardiotocographs into the consultation channel.
Objective: We aim to improve the quality of medical decision made in obstetrical emergencies by medical residents by designing and implementing a teleconsulting system that allows them to enhance the quality and amount of patient information shared with the supervising specialists.
Methods: The study included three phases. We used a stepwise action research, in such a way that every phase involved a design and implementation attempt followed by an evaluation and revision step. In Phase I, we used a combined method of communication, using both email (to scan and send the CTGs) and phone (to discuss patient status and the proper choice of labor manner). In Phase II, we designed a header frame for CTG scans, including several medical metadata such as mother’s age, parity, risk factors, etc to enhance the information being communicated. We also employed Microsoft Lync, an intranet conference tool, to allow GOSs and GORs to lively communicate and share information. In Phase III, which is still in progress, we employed a motorized Web conference hardware system with Adobe Connect Web conference software to upgrade the consultation into live Audio-Video conference among GOSs, GORs, and even patients. In every phase, we surveyed and interviewed GORs and GOSs and monitored Cesarean section decision rate.
Results: The decision regarding Cesarean section declined from 11.5% to 4.5% in the first eight months of system implementation, which alone was a big success. 96% of the participating GORs recognized the implemented teleconsulting system as useful or very useful when they needed a true advice regarding their patient from on-call GOSs. In addition, 90% of the GORs believed that the implemented system has been effective to very effective in leading them towards right obstetrical emergency decision. Participating GOSs, on the other side, felt more informed about the patient status, and more confident about the teleadvices they were giving during the consultation process using our system.
Conclusions: Our study showed that upgrading traditional phone-based medical consultation between medical residents and the on-call supervisors by including more information channels help medical residents make better decisions in case of obstetrical emergencies and may lower the rate of cesarean sections by uninformed decision.