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Focused Efforts by Virginia Hospitals Result in the Commonwealth Achieving Lowest Early Elective Delivery Rate in the Nation State
Early Elective Deliveries Decline from 8 Percent in Recent Years to 1.3 Percent due to Partnership Involving Virginia Hospitals, Physicians, Other Clinicians, and Health Care Stakeholders
RICHMOND, VA – Research has shown that babies carried to full term after 39 weeks of gestational age can improve birth outcomes and have lasting positive effects on lifelong health. Previously, conventional wisdom held that babies born between 37 and 39 weeks were generally as healthy as those carried to full term. Alongside that came a trend toward early elective deliveries (EED). It is now known that babies are still developing in the final weeks of gestation and that early deliveries which are not medically necessary should be avoided. To help reverse that trend, Virginia’s community hospitals and health systems, the Virginia Hospital & Healthcare Association’s Center for Healthcare Excellence, the American College of Obstetricians and Gynecologists (ACOG), the Medical Society of Virginia (MSV), the March of Dimes, and other health care providers and stakeholders have worked in recent years to reduce EEDs. That effort has yielded positive results. Over the past four years, Virginia has reduced its EED rate from 8 percent to 1.3 percent, ranking the Commonwealth first in the nation in reducing EEDs, according to federal Hospital Compare data. Virginia previously had been ranked 24th in the nation on EED rate based on Hospital Compare data released in 2014.
“The progress demonstrated by this initiative is remarkable,” said VHHA President and CEO Sean T. Connaughton. “Through this collaborative effort, Virginia went from being middle-of-the-pack among states on early elective delivery rate to the lowest in the country. This positive outcome shows that through the power of collaboration, the hospital and health system community can be a driving force in making Virginia the healthiest state in the nation.”
Concerns about EEDs stem from the knowledge that several vital organs such as the lungs, brain, and liver are among the last to fully develop during pregnancy, according to ACOG, which notes that a baby’s brain develops at its fastest rate between 35 and 39 weeks of pregnancy. Babies born too early can exhibit a range of potentially short-term and long-term health challenges.
A sea change in attitudes towards EEDs occurred as research and studies led by hospitals and other health care institutions demonstrated the medical efficacy of avoiding early elective deliveries to enhance birth health, explained Dr. Stephen Bendheim, an MSV member and past ACOG state chapter chairman who practices at Virginia Physicians for Women.
“When the data came out, it was eye-opening to a lot of people, hospitals, and insurers,” recalled Dr. Bendheim. “There are several benefits of waiting until after 39 weeks. One, babies tend to do better. And there’s a lower c-section rate, which leads to lower morbidity and mortality of moms and babies. Ultimately, we need to do what we know is best for our patients and babies in the long-term.”
As part of the focus on EED reduction, 53 Virginia hospitals working under a joint initiative agreed to seek ways to limit early elective deliveries. Participating hospitals pledged to submit monthly tracking data on the total number of births at individual facilities, and the number of births occurring between 37 and 39 weeks. When this initiative began in late 2012, Virginia’s EED rate was 8 percent (the national goal was 4 percent). Significant improvement has occurred since then to the point that the most current data available show Virginia has the lowest EED rate in the nation, and in the process has exceeded the national goal of 2 percent.
Dr. Alta DeRoo, director of OB/GYN services at Novant Health UVA Health System Culpeper Medical Center, noted that her hospital has a multi-tier review process to evaluate any early elective delivery request.
“It’s great to see we’ve come full circle on early elective deliveries in Virginia to the point that we have achieved the lowest early elective delivery rate in the nation,” said Dr. DeRoo. “Reducing early elective deliveries prior to 39 weeks of gestational age, with exceptions for cases where it is medically appropriate, is a positive step to promote healthy babies and the health of mothers.”
Carilion Clinic’s New River Valley Medical Center implemented a plan of action that was written into a formal practice guideline specifying that if a physician is called to schedule induced labor, only a member of the clinical leadership team can schedule the procedure, and only after checking to determine if the baby has reached a gestational age of 39 weeks. It has produced significant EED reductions.
“The last EED we had was in September, and it involved a physician insistent on scheduling an induction because the mom had a recent diagnosis of breast cancer and was scheduled for surgery in four days,” said Megan S. Barefield, RN, MSN, the Director of The Birthplace, an award-winning labor, delivery, recovery, and postpartum unit at Carilion New River Valley Medical Center in Montgomery County.
Reducing EED is also consistent with goals established by the Commonwealth of Virginia in Virginia’s Plan For Well-Being, 2016-2020, which cites a “Strong Start for Children” as one of its four primary objectives. Virginia’s hospitals are often the site where new babies arrive in the world – more than 94,000 babies were delivered in Virginia hospitals in 2015.
About VHHA: The Virginia Hospital & Healthcare Association is an alliance of 107 hospitals and 30 health delivery systems that develops and advocates for sound health care policy in the Commonwealth. Its mission is to achieve excellence in both health care and health. Its vision is through the power of collaboration to be recognized as a driving force behind making Virginia the healthiest state in the nation. Connect with VHHA through Facebook, Twitter, YouTube, LinkedIn, and ISupportVirginiaHospitals.com.
Download the full press release here.
Download the EED infographic here.
Download an EED reduction analysis here.
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