Forty Reasons To Go the Full Forty- Reducing Early Elective Delivery (EED)

Ruth Hommertzheim RN, MSN, APRN, ACNS-BC, CNS-CP, CNOR

Objectives

1. Define Early Elective Delivery (EED)

2. Discuss the risks associated with EED

3. Demonstrate why this issue is relevant to employers

4. Demonstrate how Via Christi Health has organized to eliminate EEDs

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Defining Early Elective Delivery (EED)

Unless there is a valid health reason or labor starts naturally, delivery should NOT occur before at least 39 weeks.

Medical reasons may occur where the benefits of having the baby early outweigh the potential risk.

Risk Factors Age / Race Pregnancy Weight Prenatal Care (18months prior to conception) Maternal Education Reproductive History Tobacco Use During Pregnancy

Source: American Congress of Obstetricians and Gynecologists (ACOG)

Risk Factors and Impact

Potential Impact: Mom Post Partum

Hemorrhage

Infection Postpartum depression

Stronger, more frequent contractions

Cesarean delivery

Potential Impact: Baby Feeding Difficulties Respiratory Morbidity

Neonatal Sepsis Infant Mortality Lower Brain Mass

Low Birth Weight Longer Hospital Stay

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Source: American College of Obstetrics and Gynecology (ACOG) April 2016

United States Earns a Grade of “C”: 380,000 Babies Born Preterm Annually

5 Source: http://www.marchofdimes.org/materials/premature-birth-report-card-kansas.pdf

March of Dimes State Report: Kansas Earns a “B” Grade

Source: http://www.marchofdimes.org/materials/premature-birth-report-card-kansas.pdf

Preterm Birth Rate

8.7% Grade

B City Rate Grade Status

Wichita 9.7% C

Kansas City 8.9% B

Overland Park 8.3% B

Topeka 9.2% B

The status indicator shows whether the 2013 city rate is higher , lower , or the same as the 2013 state rate (8.9%).

March of Dimes 2020 Target Rate: 8.1%

Sedgwick County Fetal Infant Mortality Rate: 15.4%

By the Numbers

Source: American Hospital Association; March of Dimes; Association of State and Territorial Health Officials 2014

10% – 15% 9.0% 92.4% Percent of preterm births in the United States performed

early without a medical reason

Percent of preterm births in the United

States paid by Medicaid

Percent of women surveyed reported

giving birth before 39 weeks is safe

$20,000 Average cost of

medical care in the 1st year of life for a

preterm baby covered by Medicaid versus

$2,100 for a full-term baby

$75,000,000 Medicaid savings that would be realized with

a 10% reduction in deliveries occurring

before 39 weeks

Preterm Delivery is Expensive

Each premature / low birth weight baby costs…

12 times as much in

health care costs as babies born without complications

An additional

$49,760 in newborn health care costs

An additional $58,917 when maternal costs are added

8 Source: Premature Birth The Financial Impact on Business, March of Dimes Foundation, 2013.

The Cost to Employers

One in nine babies are born prematurely and employers spend more on the one premature baby than on the other eight babies combined

9 Source: Premature Birth The Financial Impact on Business, March of Dimes Foundation, 2013

Healthcare Providers: Payment and Quality Scores Based on EED Reduction

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Physicians: ACOG American Congress of Obstetricians and Gynecologists

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National Professional Organizations

Nursing: AWHONN Association of Women’s Health, Obstetric & Neonatal Nurses

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Forty Reasons to Wait

Ascension and Via Christi’s Commitment

Leveraging the National Ascension Health

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Ascension Hospital Engagement Network (HEN) Part I 2013 – 2014

Hospital Improvement Innovation Networks (HIINs) Regional, State, national or hospital

system level Sustain and accelerate progress

and momentum to reduce harm in the Medicare program, help identify solutions already working and disseminate them to other hospitals and providers.

Perinatal Safety Committee

High Reliability Processes Clinical Care Excellence National Programs Kansas Healthcare

Collaborative Simulations: Noelle Post Partum Hemorrhage Shoulder Dystocia Eclampsia

Adverse Events HANDS Team STEPPS Post Partum Hemorrhage Shoulder Dystocia

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Plan Do Study Act (PDSA): Rapid Cycle Improvement

Physician Office Integration

Leaders & Associates Inclusion/Exclusion Criteria

Data Collection

Dinoprostone (Cervidal) Bishop Score Dilation, Effacement, Station,

Cervical Consistency & Position

Kansas Healthcare Collaborative is Achieving Results (2012 - current)

Met Goals

Poster

Adopted TJC/CMS PC-01

Identified Key Drivers

Identified Biggest Influencers

Medical Review of Deliveries

Hard STOP Policies

Partnerships, March of Dimes and etc.

Source: Kendra Tinsley

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Ascension Hospital Engagement Network: Part II (2015)

Ascension Health Engagement Network (2015 – 2016)

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Results Support the Approach: Zero EEDs since 2014

• 0%, yippee • Last fall out was Sept 2014

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Breastfeeding: Health Benefits + Reduced Costs

The Kansas Breastfeeding Coalition reports:

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Only 35% of employers

in Kansas report having

a written policy to

support their breastfeeding

employees

Source: Kansas Breastfeeding Coalition, “The State of Breastfeeding in Kansas” 2016.

Via Christi Exclusive Breastfeeding

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IF Early Delivery Medically Indicated: Top Three Diagnosis Codes

Mom: 1. Hypertension 2. Gestational Diabetes 3. Eclampsia Newborn: 1. Abnormal Fetal Heart Rate 2. Fetal Malformations 3. Fetal Death

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Via Christi and the Community: Building a Clinically Integrated Network of Care

Prenatal Care

Labor

Delivery

Post Delivery

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EED and Breast Feeding Resources

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Prenatal Care Resources

Physician Office Integration Baby Talk (KDHE Funded) Targets high risk and Medicaid Focus on decreasing fetal infant

mortality rate

Enhanced Referral Processes Participation Incentives Car seat or Crib

Via Christi Programs Birth Plan Best for Baby

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Labor Resources

24/7 on-site Laborist Neonatal Intensive Care Locked Unit Certified Nurses Monthly Simulations Hands and TeamSTEPPS Resources

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Delivery Resources

Baby Friendly Program

Lactation Support

Breast Feeding

Birth Registry

Locked Unit

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Post Delivery Resources

Physician Social Worker Community Resources Breast Feeding Clinic Certified Lactation Specialists Grant-funded halo bassinets to eliminate

bed sharing Safe Sleep: SIDS & Community Baby

Shower

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Questions / Comments

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