Keep Calm and Carry On: Reducing Elective Early-Term Deliveries

Abstract

Childbearing Poster Presentation Purpose for the Program Delivery before 39-week gestation is associated with increased neonatal morbidity and mortality. Significant risks associated with early-term delivery (defined as 37–38 6/7 weeks of gestation) include respiratory distress, transient tachypnea of newborn, admission to the neonatal intensive care unit (NICU), temperature instability, hypoglycemia, feeding difficulties, and high rates of hospital readmission. Elective delivery frequently is used to accommodate patient and physician convenience, with an increased risk that it may be performed earlier than is appropriate. In an effort to reduce neonatal complications, the March of Dimes and American College of Obstetricians and Gynecologists recommend that elective delivery should not occur before 39 weeks of gestation. A multidisciplinary team of professionals at Baptist Hospital of Miami collaborated to adopt the 39th week of gestation elective early-term delivery initiative, with voluntary data collection reported to Leapfrog Group. Proposed Change The staff at Baptist Hospital of Miami (BHM) proposed to evaluate their elective early-term delivery scheduling processes and implement changes aimed to decrease elective early-term delivery rate to a benchmark proposed by the Leapfrog Group. Implementation, Outcomes, and Evaluation The first step of the evaluation involved retrospective data collection that demonstrated the elective early-term delivery rate was 30%. Educational programs were then presented to physicians and obstetric personnel that emphasized the importance of the initiative with the ultimate goal to decrease the incidence of elective early-term deliveries to the nationally proposed benchmark rate. Through implementation of educational programs for medical personnel and patient population, surveillance of elective delivery schedules, and enforcement of practice policies, including elimination of psychosocial indications for early delivery scheduling, the rate of elective early-term delivery steadily decreased from 30% to 5.1% during a period of 4 years. This decrease in early delivery rate occurred simultaneously with a decrease in associated NICU admissions from 14 cases in 2009 to 2 cases in 2013. These results demonstrate a necessity for multidisciplinary vigilance against needless early-term deliveries and shared responsibility for policy compliance to ensure optimal patient outcomes. Implications for Nursing Practice Improved adherence to The Joint Commission recommendations with reduction of early-term elective deliveries can be accomplished through initiatives that involve education, surveillance of elective delivery schedules, enforcement of practice policies, and ongoing outcome data collection and evaluation. Through the application of evidence-based practice, nurses are empowered to monitor elective deliveries with direct result to patient outcomes.