Objective:  Study the clinical outcomes of an intervention to comply with the IHI 39 week induction initiative

Design: Retrospective study

Setting: Hospital settings ranging from small rural community to large urban teaching hospitals

Patients/Participants: An aggregate of 157,283 births between 2007 and 2011

Methods:

All hospitals were participating in a quality improvement program with two common aspects. 1. An intelligent medical record, (PeriBirth, Princeton, NJ) that recognizes the intention to deliver or induce electively under 39 wks and requests written justification  2. Structured quarterly performance reviews using PeriBirth reports on rates of elective induction or caesarean under 39 wks and other related topics.  In addition, some participating institutions had formal objectives to reduce elective delivery under 39 wks, others did not.   Electronic birth records were examined for:  elective inductions under 39 weeks gestation, all inductions under 39 weeks gestation, primary c-sections and 5 minute apgar scores.

Results:  

Rates fell for; elective induction under 39 wks* 0.98%-0.53%, induction under 39 wks for any reason* 11.7%-9.5% and most clinically significant, for all births under 39 wks* 43.9% -38.0%. The rates of both primary cesarean and 5-minute Apgar scores between 0 and 6 showed no change during the study period.  Overall induction rates* rose during the study period from 32.6%-35.9%. (*P <0.0001 for trend).

Conclusion/Implications for nursing practice: The intervention was highly successful in reducing elective inductions under 39 wks without an increase in the rate of primary caesarean or low 5-minute Apgar scores.  In addition, clinical behaviour changed beyond the strict confines of “elective” induction, as we observed an unexpected decrease in induction rates under 39 wks for any indication. This translated to a large reduction in the rate of birth below 39 wks.  Furthermore, these hospitals have greatly exceeded a recommended bench mark of <5% for elective delivery under 39 wks with their aggregate rate of 1.4% in 2011.  Nursing implications are that with focused attention, communication and technologic tools, providers will change their clinical behavior which may have  positive clinical outcomes on the patients.  Nursing strategies to maintain the gain will involve further research and techniques to engage the providers.

Keywords:  Reduction in labor inductions clinical outcomes