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
2
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
4
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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