Leveraging the Electronic Medical Record for Obstetric Quality Improvement

Abstract

INTRODUCTION: Four community hospitals, with 10,000 annual births combined, joined forces to eliminate nonmedically indicated births at less than 39 weeks of gestation. The aims of the project were to avoid neonatal complications related to birth less than 39 weeks of gestation and to reduce cesarean delivery rates. The leadership team for the project included the chairs of the hospital departments of obstetrics and gynecology, the employed physician group in the Health System, and affiliated nursing leaders. METHODS: Quality specialists at each hospital shared data with the leadership team, who then educated patients, nurses, and obstetric caregivers about the project. All hospitals required a Scheduled Delivery Checklist, faxed to the hospital before admission for scheduled delivery. The chair contacted the obstetric provider to discuss and postpone nonmedically indicated scheduled births at less than 39 weeks of gestation. Periodic reports were shared with hospitals and health care providers. In 2013, the health system adopted an obstetric electronic medical record with structured documentation and data collection to replace manual data collection. In 2014, electronic dashboards were developed and expanded to report on several obstetric quality measures at the hospital and health care provider level. RESULTS: In 2011, the rate of nonmedically indicated births at less than 39 weeks of gestation was 22%. In 6 months, the rate dropped to below 5% and has been sustained for 3 years through ongoing monitoring. The rate of cesarean delivery for low-risk first births decreased by 17% by the first half of 2014. IMPLICATION: Leadership engagement and ongoing monitoring through the electronic medical record are vital to sustained improvements in obstetric care.