Jacqueline John

Tawam Hospital, AlAin, United Arab Emirates

Evaluating and Enhancing Clinical Decision-Making for Induction of Labor in Low-Risk Patients: A Quality Improvement Initiative at a Tertiary Care Center in the Middle East

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Biography

Jacqueline John is currently a Fellow in Robotic Gynecology at Aster Medcity, Kerala, India. She holds prestigious qualifications including MRCOG (UK), MRCPI-ObGyn (Ireland), and the Emirati Board of Health Specialization in Obstetrics and Gynecology (UAE). She is also GMC registered in the UK. She completed her residency at Tawam Hospital, Abu Dhabi, UAE, where she served as Chief Resident and earned multiple accolades for her academic presentations and leadership. With a strong passion for minimally invasive gynecology, she is committed to advancing surgical care through innovation and precision. In addition to her clinical work, she is pursuing a Master’s in Leadership in Healthcare from the University of Warwick, UK. She is deeply invested in healthcare quality improvement and actively leads initiatives aimed at optimizing patient care and system efficiency. Her dedication and multifaceted expertise make her a promising leader in the future of women's health.

Abstract

Introduction: Induction of labour (IOL) is a frequently performed obstetric intervention, but inappropriate use in low-risk pregnancies can lead to avoidable complications and poor maternal experience. To ensure evidence-based and safe practice, standards for this project were established in line with the Department of Health Abu Dhabi intrapartum care guidelines (2022) and the National Institute for Health and Care Excellence (NICE) guidelines (2021). This Quality Improvement (QI) project was conducted in a tertiary maternity unit to evaluate existing practice, identify gaps, and implement sustainable improvements in the management of IOL in low-risk women.

Scope: The project ran from December 2022 to July 2024, with an initial audit (July–December 2022), a re-audit (January–June 2024), and final presentation in July 2024.

Methods: A multidisciplinary QI team applied the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. Interventions included departmental meetings, structured education sessions for junior and senior obstetricians, enhanced patient counselling, and standardised care pathways supported by electronic documentation.

Results: The baseline audit (2022) revealed that 34% of IOL cases were unindicated, with several not aligned to national or international guidelines. The caesarean section rate was 24%, maternal dissatisfaction stood at 59% (due to prolonged labour and inadequate information), and 18% of women experienced complications including hyperstimulation and prolonged hospital stay (>48 hours).

Following interventions, the re-audit (2024) demonstrated significant improvements: unindicated IOL reduced to 7%, adherence to guidelines increased to 91%, caesarean section rate decreased to 17%, maternal satisfaction rose to 82%, and complications reduced to 6%. Staff awareness of protocols increased from 55% to 92%.

Conclusion: This project highlights that embedding evidence-based standards from the Department of Health Abu Dhabi and NICE, supported by education and multidisciplinary engagement, can substantially improve IOL outcomes. Comparable studies (Boulvain et al., 2016; Grobman et al., 2018) confirm that guideline-driven induction enhances maternal safety and satisfaction without adversely affecting the neonatal outcomes.