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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    • "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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    ABSTRACT: The purpose of this study is to compare mode of delivery for both nulliparous and multiparous women at term that underwent elective induction of labor to those who arrived in spontaneous labor. Medical records of 807 deliveries were reviewed. There were 566 labor patients and 241 elective induction patients. Women who underwent elective induction of labor were more likely to undergo cesarean delivery compared to those women who arrived in spontaneous labor (41.1% versus 9.9%, P = 0.001). This was true for both nulliparous women (49% versus 31%, P < 0.0001), and multiparous women (22.7% versus 1.6%, P < 0.0001). The rate of operative vaginal delivery was also increased in the elective induction of labor group (8.4% versus 3.6%, P < 0.0001). Operative vaginal delivery was statistically significant in multiparous women (21% versus 4.1%, P < 0.0001), but not in nulliparous women (10.1% versus 9.8%, P = NS). Elective induction of labor at term is associated with an increased risk of cesarean section in both nulliparous and multiparous women. There is also an increased risk of an operative vaginal delivery in multiparous women who underwent elective induction of labor.
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