Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth

被引:83
作者
Clark, Steven L. [1 ]
Frye, Donna R. [1 ]
Meyers, Janet A. [1 ]
Belfort, Michael A. [1 ]
Dildy, Gary A. [1 ]
Kofford, Shalece [1 ]
Englebright, Jane [1 ]
Perlin, Jonathan A. [1 ]
机构
[1] Hosp Corp Amer, Womens & Childrens Clin Serv Grp, Nashville, TN USA
关键词
elective delivery; patient safety; practice change; TERM; INFANTS; BIRTHS;
D O I
10.1016/j.ajog.2010.05.036
中图分类号
R71 [妇产科学];
学科分类号
100211 [妇产科学];
摘要
OBJECTIVE: No studies exist that have examined the effectiveness of different approaches to a reduction in elective early term deliveries or the effect of such policies on newborn intensive care admissions and stillbirth rates. STUDY DESIGN: We conducted a retrospective cohort study of prospectively collected data and examined outcomes in 27 hospitals before and after implementation of 1 of 3 strategies for the reduction of elective early term deliveries. RESULTS: Elective early term delivery was reduced from 9.6-4.3% of deliveries, and the rate of term neonatal intensive care admissions fell by 16%. We observed no increase in still births. The greatest improvement was seen when elective deliveries at <39 weeks were not allowed by hospital personnel. CONCLUSION: Physician education and the adoption of policies backed only by peer review are less effective than "hard stop" hospital policies to prevent this practice. A 5% rate of elective early term delivery would be reasonable as a national quality benchmark.
引用
收藏
页码:449.e1 / 449.e6
页数:6
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