Worth The Wait: Reduction In <39 Weeks Elective Deliveries

Purpose:
In April 2010, CMS required perinatal organizations to report <39 weeks elective deliveries. 10-15% of the 4 million deliveries in the US are elective deliveries before 39 weeks(Bergella et al.,2008). An interdisciplinary team successfully improved matenral and neonatal delivery outcomes.

Significance:
There is a decreased risk of maternal and neonatal mortality and morbidty: less preterm delivery, NICU admissions, respiratory complications, healthcare costs, and prolonged length of stay (Robinson et al., 2010).

Strategy and Implementation:
Lean Methodology was utilized by the leadership team using the DMAIC process. The team defined the goal to reduce <39 weeks elective deliveries, measure elective deliveries >37 and <39 weeks of gestation, analyze current scheduling practice of inductions and standardize forms (if patient meets <39 weeks criteria for elective delivery), improve the scheduling process and decide if patient does not meet critieria how case should be handled, and the control by reviewing and sharing data/trends. The team reviewed benchmarks and data at every phsyician and clinical staff meetings as well as the interdisciplinary quarterly Perinatal Quality and Patient Safety meetings. The roundtable discussion focused on transparency, improvements, and implementation of practice change for improved patient outcomes.

Evaluation:
The system maintains an elective delivery <39 weeks rate at 0% in 2013 for deliveries <39 weeks gestation from 4.45% 2011 YTD to 2.39% 2012 YTD led by a team of physicians, coders, staff nurses, clinical nurse specialist, clinical information analyst, and clinical managers.

Implications for Practice:
The reduction of elective deliveries <39 weeks is available on the Women's Services Website, Careline, for staff and anyone in the organization to access. The Perinatal Quality and Safety Collaborative reports and reviews core measure data, and makes recommendations and improvements if needed.