Reducing Early Elective Deliveries
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Following the recommendations of the Illinois Perinatal Quality Collaborative (ILPQC), the Illinois Hospital Association (IHA), and March of Dimes (MOD), this 426-bed community teaching hospital initiated the ILPQC Obstetric QI Initiative: “Reducing Early Elective Delivery in Illinois.”
Relevance/Significance:
Research has shown that early elective deliveries (EED) prior to 39 weeks gestation without a medical or obstetrical indication are linked to increased neonatal morbidity without benefit to mother or baby. The American Congress of Obstetrics and Gynecologists (ACOG) re-emphasized its position against deliveries before 39 weeks without a medical indication in March of 2013, because of the risks to mothers and babies.
Strategy and Implementation:
Applicable cases were reviewed and the team developed a plan to reduce EEDs. Induction of labor (IOL) policy was updated. No IOL agent would be initiated without first checking that all proper documentation was completed verifying 39 weeks or greater gestation; or if under 39 weeks a medical indication was clearly documented. The process was hardwired and became a key process indicator for nursing staff and physicians. Empowered nursing staff worked closely with the Department Chairman, Nursing Director and Perinatal Coordinator to intervene on scheduled cases that did not meet criteria for EED. These cases were rescheduled for a later date. Audits were performed on all inductions of labor to assure 100% compliance consistent with ACOG standards for dating and medical indications for EED. The ILPQC data system, where the hospital submitted PC-01 data for 2013-2014, allowed for rapid response reporting of the hospital's EED rate in comparison to other hospitals in the state.
Evaluation:
2014 EED rates for this institution remained under the 5% benchmark for the ILPQC initiative. The hospital received a commendation letter from the ILPQC for the success of the hospital's quality improvement and patient safety efforts to reduce EEDs. “Improving the Quality of Care for Moms and Babies” banner was awarded by the MOD for two consecutive quarters of EED rates of less than 5%.
Implications for Practice:
This institution's success largely credited to the interprofessional and collaborative teamwork between physician's and nursing staff is a critical step towards improving birth outcomes and reducing costs associated with non-medically indicated EEDs and elective cesarean sections.