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Maricopa Sustains Zero EEDs through Standardization, Education

Unsatisfied with its existing early elective delivery (EED) rate – which stood at 3.7 percent for 2010 – Maricopa Integrated Health System (MIHS) adopted a new policy that standardized acceptable medical indications for deliveries before 39 weeks and enhanced patient and clinician education efforts. In less than 1 year, the transformation helped the Phoenix, Ariz.-based safety net system achieve a zero EED rate and produce continued results.

After analyzing its EED performance in 2010, MIHS recognized opportunities for improvement. To reduce EEDs across the organization, staff formed an interdisciplinary quality and research group to review evidence-based practices and select high-potential strategies to implement at MIHS.

Based on the group’s findings, MIHS standardized criteria for performing medically indicated early deliveries, which included specific dating guidelines to determine gestational age. Next, MIHS educated providers on the new policy and the dangers of delivery before 39 weeks.

This education, coupled with an effort to empower nurses to enforce the policy, helped reduce noncompliance. In addition, MIHS communicated EED risks to patients early in prenatal care, setting an expectation that the procedure would be prohibited without a medical indication.

Armed with the new EED policy and an improved patient and provider education strategy, MIHS has successfully kept its EED rate at zero for 28 consecutive months. According to the “Improving America’s Hospitals: The Joint Commission Annual Report on Quality and Safety 2012,” the national average EED rate in 2011 was 13.6 percent.

MIHS OB team members urge other hospitals working to reduce EEDs to leverage the power of physician education, saying that it was key to getting providers on board with the initiative.

In the near future, MIHS anticipates a shift in its OB patient demographics – currently 85 percent Hispanic and 93 percent Federal Emergency/Medicaid recipients – to include fewer minorities. To ensure that physicians continue to comply with the EED policy as the needs and preferences of their patients change, MIHS plans to draw support from other providers within the city, most of which have also adopted policies prohibiting EEDs. MIHS believes that a strong, unified stance against EEDs will help patients understand what a serious risk they pose to the health and safety of both the mother and child.


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