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Sustaining Zero: Standardization, Education Avert EEDs at Maricopa

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 one year, the transformation helped the Phoenix-based essential hospital 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.

Based on the group’s findings, MIHS:

  • standardized criteria for performing medically indicated early deliveries, which included specific dating guidelines to determine gestational age. 
  • educated providers on the new policy and the dangers of delivery before 39 weeks.
  • launched an effort to empower nurses to enforce the policy. 
  • 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 19 consecutive months.

MIHS obstetrical team members encourage other hospitals working to reduce EEDs to leverage the power of physician education, noting that it was an integral element to gaining support from providers for the initiative.

For more information about Maricopa’s EED program, please contact:

Maria Manriquez, MD
Vice Chair, OB/GYN Department
Maricopa Integrated Health System
(602) 344-5641


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