33: A statewide initiative to reduce scheduled births without appropriate indication

Article Outline

• Objective
• Study Design
• Results
• Conclusion
• Copyright

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Objective 

To reduce the rate of scheduled births between 36.1 to 38.6 weeks that lack appropriate medical or obstetric indication.

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Study Design 

Level 2 & 3 Ohio maternity hospitals joined a quality improvement collaborative using modified IHI Breakthrough Series^™ methods. 20 hospitals representing 47% of Ohio births collected baseline data for 60 days, then adopted locally appropriate interventions, executed iterative tests of change, and reviewed charts to document the incidence, rationale & outcome of scheduled births. De-identified birth data were sent to a central repository. Rates of scheduled births without a documented medical indication, birth certificate data, and implementation issues were shared in calls and learning sessions.

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Results 

The rate of scheduled births between 36.1 and 38.6 weeks without a documented medical indication declined from 25% to below 5% (p < .05) (Fig 1). Birth certificates from member sites recorded fewer inductions without a listed indication, declining from a 12 month mean of 13% to 8% (p < .0027). Fewer infants born at 36-38 weeks went to a NICU. 99% of charts documented dating criteria and 81% met optimal dating criteria.

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Conclusion 

A quality collaborative was associated with a significant decline in the rate of scheduled births lacking a documented medical or obstetrical indication.