Improving Outcomes by Reducing Elective Deliveries Before 39 Weeks of Gestation: A Community Hospital's Journey

Our goal was to improve quality and safety of care to our obstetric and neonatal patients (presenting between 34 0/7 and 36 6/7 weeks) by lowering the overall induction rate, lowering the elective induction rate less than 39 weeks, decreasing the unanticipated admissions of late preterm infants to the special care nursery (SCN), decreasing the number of transports out of our level II SCN to a higher level III neonatal intensive care unit, and increasing safety culture scores of the Family Birth Center staff at Mercy Hospital Anderson, Cincinnati, OH. A retrospective chart review was conducted over a 2-year period. In 2005, after an intense analysis of the Family Birth Center, the overall induction rate and elective induction rate of less than 39 weeks' gestation were at an alarming 26.4% and 12.1%, respectively. Best practice guidelines for scheduling an induction were developed in collaboration with nursing and medical staff. These elective induction guidelines required patients to have completed 39 0/7 weeks of gestation and to have a Bishop score of at least 8 for nulliparas and 6 for multiparas. In 2006, the induction scheduling process and these newly developed guidelines were strictly enforced. In 2007, outcomes including total induction rate, elective induction rate for less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and SCN unanticipated admissions of infants 34 0/7 to 36 6/7 weeks' gestation (late preterm infants) were compared with these same measures in 2005.