Reducing Early Elective Deliveries (EED)
Early Elective Delivery (EED) before 39 weeks gestation may result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis and hypoglycemia for the newborns (Tita et al., 2009). A study in the American Journal of Obstetrics and Gynecology estimated the cost of such deliveries to be nearly $1 billion dollars per year. The American College of Obstetrics and Gynecology (ACOG) recommends against non-medically indicated delivery prior to 39 weeks and recommends that all hospitals put in place a hard stop policy against this practice. The Illinois Department of Public Health (IDPH) also recommends implementation of a hard stop policy for all maternity hospitals in the state.
ILPQC partnered with the Illinois Hospital Association, March of Dimes, IDPH and HFS to move forward the first ILPQC Obstetric QI Initiative: Reducing Early Elective Delivery in Illinois. At that time, many hospitals were already working on reduction of early elective delivery in Illinois. ILPQC was positioned to assist hospitals with data assessment, obtaining tool kits and focusing on quality improvement by learning from national experts and hearing lessons learned from other hospitals across the state. IDPH released provisional birth certificate data on early elective delivery to Illinois birthing hospitals. The birth certificate data, although not able to capture all indications for early elective delivery, allowed for comparison across hospitals and across time using the same data elements captured from birth certificates across the state. ILPQC worked with hospitals to identify methods of improvement for birth certificate data collection and also to standardize the current data collected on early elective delivery so that accurate rates could be used to assist hospitals with quality improvement efforts across Illinois.
ILPQC, in collaboration with the Illinois Hospital Association and the March of Dimes, provided a series of OB Quality Boot Camps to Illinois birthing hospitals to provide OB quality learning sessions and a forum for hospitals to ask questions regarding the ILPQC initiative and the IDPH birth certificate data. In addition, ILPQC worked with the ILPQC OB Advisory Workgroup to develop an Early Elective Delivery data form and data dictionary to provide hospitals a standard form that should match the Joint Commission Data that they were already collecting. ILPQC created a data system that allowed hospitals to submit Early Elective Delivery data and provided monthly reports to hospitals so that hospitals could assess their progress over time and compare themselves to other hospitals. All hospital data is held securely and hospital names / locations are never reported with the data.
Initiative Aim and Outcome
Aim: Reduce EED to <5% across >=95% of participating hospitals and improve ability for hospitals to compare accurate EED data across time and across other Illinois hospitals.
Outcome: Of 40 hospitals reporting 2014 Q4 PC-01 data, 87.5% have <5% EED. The baseline EED rate for 40 hospitals reporting data (Q1 2013) was 2.32%. In Q4 of 2014 for 40 hospitals reporting data it is 1.81%, a 0.51% decrease.