Implementation of an Enhanced Prenatal Checklist to Increase Rates of Counseling of Prenatal Fetal Aneuploidy Testing

TL;DR

Using a checklist in prenatal visits increased discussions about fetal aneuploidy testing and genetic counseling referrals.

Contribution

An enhanced prenatal checklist was implemented and shown to improve counseling rates for fetal aneuploidy testing.

Findings

The rate of discussion about diagnostic prenatal genetic testing increased from 54% to 72% after implementing the checklist.

For patients with advanced maternal age, the discussion rate rose from 53% to 83%, and referrals increased from 4% to 38%.

Abstract

Aim

This study aims to assess the effect of implementing an enhanced prenatal genetic checklist to guide the provider’s discussion on both screening and diagnostic options for fetal aneuploidy testing at the initial prenatal visit.

Methods

A retrospective quality improvement (QI) project was performed at a single, large, urban academic medical center. The implementation of this project was prospective; however, data was examined retrospectively after the QI initiative was implemented for three months. Patients were included if they were less than 24 weeks gestational age with a live intrauterine gestation at their initial obstetric (OB) visit. Patients less than 18 years old at the initial OB visit were excluded. The results were analyzed using the statistical software R. Chi-squared tests were used to examine proportional differences between the pre- and post-intervention groups with respect to demographic and clinical characteristics and documented genetic counseling discussions.

Results

A total of 416 patients were included in the final cohort. As measured by documentation, the rate of discussion of diagnostic prenatal genetic testing increased significantly from the pre-intervention proportion of 54% to the post-intervention proportion of 72% (p < 0.001). In the subgroup analysis of patients with advanced maternal age, the rate of discussion of diagnostic prenatal genetic testing increased significantly from the pre-intervention proportion of 53% to the post-intervention proportion of 83% (p = 0.003), and the rate of genetics counseling referrals made at the initial prenatal visit increased significantly from 4% pre-intervention to 38% post-intervention (p < 0.001).

Conclusions

The use of an enhanced prenatal genetic checklist led to increased discussion of diagnostic fetal aneuploidy testing and increased rates of referral to genetics counseling.

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