Objective:  Hospitals are implementing paperless systems for electronic fetal monitoring (EFM) interpretation.   With the introduction of these systems, EFM tracings are visually interpreted using computer screens and computer printouts instead of the traditional, scrolling paper mode.  The history of EFM and established interpretation theory has been based on the visual interpretation of paper tracings.  The process of interpretation using computer modes is potentially different.  Each mode allows a different amount of tracing to be viewed simultaneously, produces an image in different colors and with different reference lines, and involves either static or moving images.  A concern is that all three modes are used interchangeably without proof that a satisfactory correlation exists.  Is there a difference in EFM tracing interpretation depending on the mode used?

Design: Retrospective, descriptive correlational study of EFM tracing records 

Setting: The birth center of a large, university medical center

Patients/Participants: The tracing records of 13 patients were collected and reviewed by 5 experienced intrapartum RNs. 

Methods: 1½ to 2 hours of tracing was collected for each patient in each mode.  Tracings were randomized, and then assessed for uterine activity and fetal heart rate characteristics and assigned an interpretative label every 15 minutes (6-8 assessments per tracing, N=1515).

Results:  Crosstabulation using chi-square analysis was performed.  A significant difference (p = 0.26) in perception of decelerations was found.  More decelerations were identified in the computer screen mode.  In addition, there was a significant difference (p = .009) in the interpretative label assigned to the tracing.  More tracings were assessed as nonreassuring in the computer screen mode.

Conclusion/Implications for nursing practice: The visual interpretation of FHR tracings is used to assess fetal well-being, the presence of labor, and the adequacy of labor.  The accuracy of this interpretation fundamentally affects the care of the pregnant woman and fetus.  Most hospitals use some combination of computer-generated FHR images and paper tracing images for bedside interpretation, central surveillance, “down times,” and archiving.  The assumption that these modes are interchangeable may be suspect given the findings of this study.  Poor correlation between visual modes potentially could lead to inaccurate assessments, inconsistent communication, inappropriate interventions, and increased vulnerability during litigation.  More research is needed to either support or refute the equivalence of the three modes when interpreting EFM tracings.

Keywords:  electronic fetal monitoring, EFM tracing interpretation, EFM research