Medical professional societies, government leaders and national advocacy groups have encouraged physicians and hospitals to discontinue early-term, non-medically necessary deliveries. Hospitals have an important role to play, and several have implemented hard-stop policies to eliminate them. These policies include adopting a scheduling procedure that requires physicians to provide a medical indication before performing an early-term delivery or seeking approval from the department chair or another authorized person.
Woman's Hospital's launched its initiative in 2007 through a collaborative with the Institute for Healthcare Improvement. As a result of the policies we have implemented, admission of premature babies into our NICU has declined by more than 25%. In 2011, Louisiana's Department of Health and Hospitals joined the effort as the first state agency to target elective births before 39 weeks, and Woman's helped obtain signed pledges from hospitals in the state that performed more than 1,000 deliveries annually. In 2012, DHH modified the birth certificate to require the reason for delivery before 39 weeks gestation. DHH also provided financial assistance to participating hospitals to offset the cost of IHI membership so that hospitals are equipped with the tools they need to be successful. Because 70% of the babies in Louisiana are covered by Medicaid, it was a smart investment.
We began our journey by forming a multidisciplinary council of nurse managers, quality specialists, administrators, physicians and the medical director. Team members, including nurse champions and community physicians, attended national meetings and IHI conferences every six months to review evidence-based practices and discuss progress with other organizations in the same pursuit.
Our team shared what they learned at the IHI meetings with staff and led a discussion on Woman's most recent data. The entire team analyzed discrepancies in the data and suggested changes that could perfect the guidelines and improve outcomes. All team members provided input and came to an agreement on the appropriate next steps for Woman's Hospital.
This type of collaboration was essential. To alleviate tension among patients and their families, physicians and the hospital, obstetricians were encouraged to advise patients that hospital regulations prohibited early-term deliveries that are not medically necessary. Obstetric patients received pamphlets during prenatal visits identifying the potential risks associated with births, the importance of waiting was discussed in prenatal classes and we worked with the March of Dimes to increase awareness.
Pediatricians also assisted by explaining the risks to the baby with expectant parents. The discomfort and inconvenience that caused mothers to request inductions quickly dissipated when they understood the consequences of delivering early.
The implementation of hospital policies to reduce early-term, non-medically necessary deliveries requires the investment of considerable resources to collect the data, monitor progress and educate employees, the medical staff, patients and their families. But the benefits of protecting the health of newborns far outweigh the costs. And although revenue in the NICU has been reduced considerably because of the elimination of admissions for early-term deliveries, we never questioned the decision because it is simply the right thing to do.