Unexpected Effects of Reducing Elective Inductions at Less Than 39 Weeks Gestation

Authors


Poster Presentation

Objective

Study the clinical outcomes of an intervention to comply with the Institute for Healthcare Improvement's 39-week induction initiative.

Design

Retrospective study.

Setting

Hospital settings ranging from small rural community to large urban teaching hospitals.

Patients/Participants

An aggregate of 157,283 births between 2007 and 2011.

Methods

All hospitals were participating in a quality improvement program with two common aspects. First, an intelligent medical record (PeriBirth, Princeton, NJ) that recognizes the intention to deliver or induce electively at less than 39 weeks gestation and requests written justification. Second, structured quarterly performance reviews using While to mention PeriBirth once, as the tool used in the study; PeriBirth is owned by PeriGen, and additional mentions becomes promotion. Intelligent medical record reports on rates of elective induction or cesarean at less than 39 weeks gestation and other related topics. In addition, some participating institutions had formal objectives to reduce the rate of elective births at less than 39 weeks gestation, others did not. Electronic birth records were examined for elective inductions at less than 39 weeks gestation, all inductions at less than 39 weeks gestation, primary cesareans, and 5-minute Apgar scores.

Results

Rates fell for elective induction at less than 39 weeks gestation* 0.98% to 0.53%, induction at less than 39 weeks for any reason* 11.7% to 9.5%, and most clinically significant, for all births at less than 39 weeks* 43.9% to 38.0%. The rates of primary cesarean and 5-minute Apgar scores between 0 and 6 showed no change during the study period. Overall induction rates* rose during the study period from 32.6% to 35.9%. (*p < .0001 for trend).

Conclusion/Implications for Nursing Practice

The intervention was highly successful in reducing elective inductions at less than 39 weeks gestation without an increase in the rate of primary cesarean or low 5-minute Apgar scores. In addition, clinical behavior changed beyond the strict confines of “elective” induction, as we observed an unexpected decrease in induction rates at less than 39 weeks for any indication. This translated to a large reduction in the rate of birth at less than 39 weeks. Furthermore, these hospitals have greatly exceeded a recommended benchmark of <5% for elective birth at less than 39 weeks gestation with their aggregate rate of 1.4% in 2011. With focused attention, communication, and technologic tools, providers will change their clinical behavior, which may have positive clinical outcomes on the patients. Nursing strategies to maintain the gain will involve further research and techniques to engage the providers.

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