Nurse champions, two physicians, new guidelines and hard work helped a Tampa, Fla., hospital reduce its rate of early-elective deliveries by 91% in one year.
St. Josephs Womens Hospital had a 38.6% rate of early-elective births, defined as occurring when 37 to 38 weeks of gestation is completed. That rate dropped to 3.3% during 2011, meaning more babies were born through full-term deliveries at 39 to 41 weeks of completed gestation.
And the hospitals success has continued. The rate of early-elective deliveries decreased to less than 1% in 2012, according to the hospital. “As patient advocates, nurses are always delighted to see improved outcomes in patients, and we really saw a decrease in admits to the NICU and [transition]nursery with the change in practice,” Karen Howell, RN-C, director of patient care services at the hospital, said.
The goal of the project was to decrease the rate of complications or medical issues that can affect infants who are delivered early. Infants delivered at 37 weeks of gestation have higher rates for respiratory failure and ventilator use than babies born at 39 weeks of gestation, according to a Consortium on Safe Labor study cited in an April 2013 committee opinion from the American Congress of Obstetrics and Gynecologists.
How they did it
St. Josephs, a 192-bed specialty hospital, was one of five facilities in Florida chosen to participate in a program, partially funded by the March of Dimes, to reduce early-elective deliveries before 39 weeks. The program involved five hospitals each in Florida, New York, Illinois, Texas and California — states that make up about 40% of the nations births, Howell said.
The hospital used the “Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age; A Quality Improvement Toolkit” developed by the March of Dimes, California Maternal Quality Care Collaborative and the California Department of Health, Maternal Child and Adolescent Health Division.
St. Josephs formed a perinatal safety committee of obstetricians and nursing leaders that created guidelines for physicians to follow in scheduling inductions and cesarean sections, Howell said. The guidelines also educated physicians about what were “medically indicated” elective deliveries.
Two nurses who schedule inductions examined scheduling forms to determine whether the early delivery was medically indicated, Howell said. If not, they notified the scheduling physician that a peer consult with one of two lead physicians on the project would be necessary.
“The peer-to-peer consult facilitated adherence to the new guidelines,” Howell said.
The hospital saw a decrease in transfers to the NICU or transition nursery as a result of lower rates of early- elective deliveries.
“The nurses were able to see the importance of the project in more [full]-term deliveries, fewer babies with respiratory issues, fewer babies with temperature instability and improved feeding,” Howell said.
Tracking the hospitals progress
The nurses who took a “hard stance” on scheduling according to the guidelines and referring physicians for peer consults “are two nurse heroes in reducing the rates of early deliveries,” Howell said.
Nurses also collected data for the one-year project on the about 600 deliveries per month that occurred at the hospital. Plus they tracked newborn outcomes, Howell said. The hospital submitted monthly data to the March of Dimes and received monthly reports showing their improvements.
“Nothing keeps you motivated on a project more than to see positive results and improved numbers,” Howell said. “Our whole nursing team is extremely proud of our physicians for this change in practice.”