Hospitals in pursuit of excellence

Elimination of Early Elective Deliveries Prior to 39 Weeks Gestation

The project includes a hard stop chain of command. When scheduling an induction or C-section, the registered nurse or designee must use the C-section scheduling form and have prenatal records ready at the time of scheduling induction, with the gestational age.

All scheduled cases must be reviewed by charge nurses 24 hours prior to the date of the induction or procedure. If the scheduled case is less than 39 weeks, the chain of command protocols must be activated. The charge nurse must inform the attending provider, the department manager or director and the chairman of perinatal services about the induction for the cases less-than 39 weeks and justification for the procedure.

This process optimizes care and addresses concerns associated with inductions or C-sections prior to 39 weeks, which are at high risk for respiratory morbidity. It also avoids deliveries between 37 and 38 6/7 weeks, which are associated with higher neonatal morbidity. The rationale for adopting accepted guidelines for indicated delivery at early term or late preterm gestational ages is to mitigate risks for women, fetuses and neonates and discourage early elective deliveries prior to less-than 39 weeks gestation.

This case study is part of the Illinois Health and Hospital Association's annual Quality Excellence Achievement Awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals and health systems in continually improving and transforming health care in the state. These organizations are improving health by striving to achieve the Triple Aim—improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care—and the Institute of Medicine’s six aims for improvement—safe, effective, patient centered, timely, efficient, and equitable. To learn more, visit https://www.ihaqualityawards.org/javascript-ui/IHAQualityAward/