1. Texas Center for Quality and Patient Safety DENNIS W. COOK, MSN, RN Senior Director/Texas Center for Quality and Patient Safety dcook@tha.org www.texashospitalquality.org www.tha.org Eliminating Elective Deliveries Before 39 Weeks (EED)

2. 2 Citation The information in the presentation has been taken from: Improving Perinatal Safety: The Elimination of Elective Deliveries Before 39 Weeks. Health Research & Educational Trust. Chicago: February 2012. Accessed at www.hpoe.org

3. 3 Why Reduce EED? Decrease the possibility of adverse neonatal outcomes: ICU Admissions Transient Tachypnea Respiratory Distress Syndrome Sepsis Feeding Problems

4. 4 Medical Reasons to Induce Labor Placenta Abruption Post-term Pregnancy (>/= 41 weeks) Maternal conditions  preeclampsia  hypertension  diabetes  chronic renal disease Fetal Problems  insufficient growth  congenital anomalies  prior stillbirth  fetal demise Psychosocial

5. 5 Texas Law Under a 2011 law, Texas Medicaid will not reimburse hospitals for elective deliveries occurring prior to 39 weeks’ gestation when not medically necessary.

6. 6 How to Eliminate EED Form a team Analyze the current situation Set a primary goal Create guidelines Collaborate with staff Implement coordination Educate physicians Track progress

7. 7 How to Eliminate EED Step 1: Form a team Involve all who have a stake in the planning and outcomes process: Physicians Administrators Operations analysts Quality department Executive leadership

8. 8 How to Eliminate EED Step 2: Analyze the current situation Analyze EED rates by facility, year, and physician to find trends. Calculate outcome metrics Compare rates to state and national trends

9. 9 How to Eliminate EED Step 3: Set a primary goal Aim to eliminate EED within a realistic time period

10. 10 How to Eliminate EED Step 4: Create guidelines In a team setting, draft sample guidelines for review

11. 11 How to Eliminate EED Step 5: Collaborate with staff Present the primary analysis to participating clinical and administrative staff Discuss sample guidelines and request feedback for improvement Review potential solutions to reach primary goal

12. 12 How to Eliminate EED Step 6: Implement coordination Pilot new guidelines to identify gaps. Revise plan before it goes into a policy.

13. 13 How to Eliminate EED Step 7: Educate physicians Develop educational materials that cover the new guidelines for physicians with less exposure to the implementation plan. Develop educational materials for physicians to give to patients describing the health risks associated with EED.

14. 14 How to Eliminate EED Step 8: Track progress Measure outcome and process metrics to gauge improvement and recognize challenges. Disseminate and discuss metrics with team and all involved staff for feedback.

15. 15 Partnership for Patients Metrics For TCQPS HEN: Process Metric Numerator: Number of elective deliveries between 37-39 weeks Denominator: Number of elective deliveries Outcome Metric Numerator: Number of injuries using ICD-9-CM codes in any diagnosis fields Denominator: Number of elective deliveries between 37- 39 weeks

16. 16 Essentials for Success Leadership Buy-in Physician Adherence Patient Education Documented Process

17. 17 Case Study Presentation Seton Family of Hospitals (Ascension Health) implemented “Journey to Zero” in 2003. Impact: There has been no elective inductions before 39 weeks within the system. Birth trauma rates decreased from 30/10,000 to 2/10,000 since 2007 (93% reduction). Zero NICU admission attributed to EED for more than six years. NICU charges declined from $4mil to $186,000/yr. Webinar on this effort will be held in May 2012. Date and Time TBD.

18. Serving Texas Hospitals/Health Systems 18