Updates

Register now for 39 weeks project!
July 12, 2009

Hospitals interested in participating in PQCNC's collaborative to eliminate elective deliveries before 39 weeks' gestation should register by July 17.  Hospitals of all sizes from across the state have expressed interest and have shared their experiences in addressing this issue on their own, and we are looking forward to joining forces to focus on this issue as a state.  Several hospitals have already completed registration.

Information needed to register:
•    names, titles and email addresses of all team members
•    identification of a primary contact person for the team
•    which learning session your team will attend (Sept. 16 in Winston Salem or Sept. 18 in Chapel Hill)
 
Once your team is registered, you will receive an email with further instructions about how to prepare for the collaborative.  If you are planning to participate but will not be able to register your team by July 17, please let us know, using the "contact us" tab at the top of the page.  We will accommodate all teams who register by the end of July.

Click here to go to the registration form.

Invitation to Join the Eliminating Elective Deliveries Under 39 Weeks Gestation
July 4, 2009

PQCNC 39 Weeks Invitation Letter

 

Download:
Download PDF

June 2009 Expert Team Meeting
June 17, 2009

The expert team met to review and finalize the data collection forms.  Several decisions were made:  

  • The list of indications on the data collection sheet will include all possible indications which the person reviewing the chart might encounter, including those that may not be legitimate medical indications for delivery before 39 weeks in the eyes of the expert panel.  The report prepared by PQCNC for each hospital will include the frequency of various indications, and each hospital's team can determine whether these are appropriate at a given gestational age.
  • A second column will be added to the list of indications asking whether the chart reviewer was able to find "objective evidence" in the chart (such as lab values, blood pressure or ultrasound report depending on the condition) to support the indication for delivery given by the clinician.
  • For the retrospective chart review, hospitals will review 25 sequential scheduled cesareans and 25 inductions from 2008, at gestational ages of 36-386/7 weeks.  This will provide a baseline of how many planned deliveries before 39 weeks were elective, while eliminating those done at earlier gestational ages, which are generally done exclusively for medical complications.
April 2009 Expert Team Meeting
April 17, 2009
The expert group guiding this project, including obstetricians, nurse managers and a clinical nurse specialist, all from hospitals who have worked to eliminate elective deliveries before 39 weeks, met by phone to develop a plan for data collection and outcome measurement for this project.  The working definition of "elective" delivery is a delivery done in the absence of a medical indication where delivery would offer a benefit to the mother or fetus/neonate.  This definition will be elaborated by combining working definitions from expert committee member hospitals and other sources, including IHI bundle definitions. Hospitals will be asked to review inductions and scheduled cesarean sections to identify the rate of non-medically indicated delivery before 39 weeks.  Data will be submitted monthly to PQCNC and will include both maternal and neonatal outcomes.   Items to be measured include length of stay on L&D and NICU admission.  The project goal was defined as such: participating hospitals will reduce the number of elective deliveries (induction and cesarean, including repeat cesarean) prior to 39 weeks gestation without a mature of amniocentesis to 90% of baseline or will totally eliminate these deliveries altogether.
Background
April 15, 2009
Elective induction prior to 39 weeks has been shown to increase the length of labor, complications of labor and cesarean section and operative delivery rates compared to women in spontaneous labor. Substantial data exist showing that infants born by scheduled cesarean section have higher rates of respiratory problems and other complications. In addition, elective deliveries (either by CS or induction) between 37 0/7 and 38 6/7 weeks have been shown to increase neonatal admissions to special care nurseries. Lastly, induction of labor is typically less efficient than spontaneous labor, tying up labor and delivery schedules.

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