Labor induction process improvement: A patient quality-of-care initiative

Magee-Womens Hospital, and Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 05/2009; 113(4):797-803. DOI: 10.1097/AOG.0b013e31819c9e3d
Source: PubMed


To examine the effects that medical staff education and a new process for scheduling inductions had on decreasing inappropriate inductions.
At our institution in 2004, guidelines were developed and shared with the medical staff and reinforced in 2005. The guidelines for elective induction required patients to have completed 39 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 was changed and the guidelines were strictly enforced. All scheduled inductions during the same 3-month time period (June through August) in 2004 (n=533) and 2005 (n=454) and during a 13-month period from November 2006 to December 2007 (n=1,806) were compared. Outcomes included elective inductions less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and the overall induction rate.
From 2004-2007, the overall induction rate dropped from 24.9% to 16.6%, a 33% reduction(P<.001); the elective induction rate dropped from 9.1% to 6.4%, a 30% reduction (P<.001); the percentage of elective inductions before 39 weeks of gestation dropped from 11.8% to 4.3%, a decrease of 64% (P<.001); and the frequency of cesarean delivery among nulliparas undergoing elective induction dropped from 34.5% to 13.8%, a decrease of 60%. (P=.01).
Medical staff education and the development and enforcement of induction guidelines contributed to a decrease in inappropriate inductions, a lower cesarean birth rate for electively induced nulliparas, and a lower elective and overall induction rate.

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    • "Considering that elective induction of labor has potential health, financial, and societal ramifications (Angood et al., 2010; Martin et al., 2007; Podulka et al., 2008; Vardo et al., 2011), there is ongoing discussion about how best to reduce, if not eradicate, this practice. Although strict hospital protocols may significantly decrease elective induction of labor (Donovan et al., 2010; Fisch et al., 2009; O&apos;Rourke et al., 2011; Oshiro et al., 2009; Reisner et al., 2009), without addressing the underlying factors, it can be anticipated that the unresolved issues will manifest in other ways. Opportunities to meaningfully implement evidence-based care and change practice will be missed in maternity care settings where strict policies are more challenging to enforce. "
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    ABSTRACT: In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link. Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve. In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
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    • "The incidence of elective induction appears to be increasing at a greater rate than medically indicated inductions and now make up over one third of the total delivery population [8-10]. In 1990, the rate of induction was 9.5%, with a sharp increase to 23% of total deliveries in 2008-a relative increase of 143% [11]. "
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    Journal of Clinical Medicine Research 08/2013; 5(4):305-8. DOI:10.4021/jocmr1476w
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    • "US birth certificate data show a 5% decrease in LPT births between 2006 and 2009. 1 An increased awareness of LPT neonatal morbidity and subsequent quality improvement initiatives, designed to decrease elective LPT and early term births, likely explain this decline in LPT births. 21–23 It is possible that decreased variation in the management of common co-morbidities affecting LPT pregnancies, if accomplished without compromising maternal outcomes, might further decrease neonatal morbidity by delaying LPT delivery. 12 Morbidity in LPT neonates decreases as gestational age increases, suggesting that delaying LPT delivery might improve neonatal outcomes even if a LPT birth cannot be prevented. "
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