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A multistate quality improvement program to decrease elective deliveries before 39 weeks of gestation.

Bryan T Oshiro1, Leslie Kowalewski, William Sappenfield

  • 1Loma Linda University School of Medicine, Loma Linda, California; the University of South Florida College of Public Health and College of Medicine, Tampa, Florida; the New York State Department of Health, Albany, New York; the University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, Texas; Carle Foundation Hospital, Urbana, Illinois; and the March of Dimes, National Office, White Plains, New York, California Chapter, San Francisco, California, Florida Chapter, Maitland, Florida, Illinois Chapter, Chicago, Illinois, New York Chapter, New York, New York, and Texas Chapter, Houston, Texas.

Obstetrics and Gynecology
|May 3, 2013
PubMed
Summary
This summary is machine-generated.

Elective early-term deliveries before 39 weeks gestation were significantly reduced by a process improvement program. This initiative successfully decreased nonmedically indicated deliveries to under 5% without increasing adverse neonatal outcomes.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Healthcare Quality Improvement

Background:

  • Nonmedically indicated (elective) deliveries before 39 weeks gestation are associated with increased neonatal morbidity.
  • Early-term deliveries scheduled electively pose risks to neonates.
  • Reducing elective early-term deliveries is a critical goal in obstetric care.

Purpose of the Study:

  • To evaluate the effectiveness of a process improvement program in reducing elective scheduled singleton early-term deliveries (37 0/7-38 6/7 weeks gestation).
  • To assess the impact of the program on neonatal morbidity and term fetal mortality.
  • To implement and analyze changes in diverse community and academic hospital settings.

Main Methods:

  • Implementation of revised policies and procedures for scheduling inductions and cesarean deliveries.
  • Provision of patient and healthcare provider education on early-term delivery guidelines.
  • Collection and analysis of data on scheduled singleton deliveries at 34 weeks gestation or higher across 26 hospitals.

Main Results:

  • Elective scheduled early-term deliveries decreased significantly from 27.8% to 4.8% within 12 months (P<.001).
  • Rates of elective scheduled singleton early-term inductions and cesarean deliveries also decreased significantly.
  • No significant changes were observed in medically indicated or unscheduled early-term deliveries, and no increase in term fetal mortality was noted.

Conclusions:

  • A rapid-cycle process improvement program effectively reduced elective scheduled early-term deliveries to below 5% in a multi-state hospital group.
  • The program demonstrated success in improving obstetric care practices without compromising neonatal safety.
  • This initiative provides a model for reducing unnecessary early-term deliveries in diverse healthcare settings.