ArticleBMJ quality & safety2024
Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis.
Article in BMJ quality & safety, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 17 citations in OpenAlex.
- Cognitive Tunneling in Obstetrics and Gynecology: A Critical Review of Implications for Clinical Practice and Mitigation Strategies.Diseases (Basel, Switzerland) · 2026Review
- Integrating equity into hospital incident reporting and patient concerns systems: study protocol for a mixed methods study.BMJ open · 2025Article
- Intersectional dynamics and care disparities in intrapartum electronic fetal monitoring: a socio-technical systems perspective.BMC pregnancy and childbirth · 2025Article
- Advancements in Fetal Heart Rate Monitoring: A Report on Opportunities and Strategic Initiatives for Better Intrapartum Care.BJOG : an international journal of obstetrics and gynaecology · 2025Review
- Differences in women's experiences of labour according to type of fetal monitoring: a quantitative analysis of an Australian national survey.BMC pregnancy and childbirth · 2025Article
- Article
- "Nothing Comes to Mind…": Challenges With Identifying One's Own Role in Preventable Adverse Outcomes in Interprofessional Birthing Unit Teams, and the Implications for Quality Improvement Initiatives.Perspectives on medical education · 2025Article
- Influences on safety of intrapartum electronic fetal heart rate monitoring practices: a scoping review.BMJ open · 2024Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundProblems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk.
methodsHuman factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method.
resultsCTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely.
conclusionsCTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.