Friday, September 14, 2012

Hospitals aim to reduce early births

Because of health risks for mother and baby, docs say it's best to wait
By Nick Tabor, New Era Senior Staff Writer
Women often choose in advance when to have their babies delivered.
Sometimes it’s because they feel serious physical discomfort in their final weeks. Other times they want to coordinate with the schedule of a visiting relative or hit a certain birthday.
But medical experts say this endangers babies’ development and even their lives, and it often harms mothers.
Now the Kentucky Hospital Association is working with 15 of its member hospitals, including Jennie Stuart Medical Center, to cease the practice except when it’s necessary. Another 15 or so may soon start participating.

Medical staff at Trover Regional Medical Center in Madisonville, who ended early elective deliveries in 2010, are helping lead the effort.
The Center for Women’s Health at Trover doesn’t just discourage patients from choosing early deliveries, said LeAnn Todd Langston, the center’s nurse manager.
“That’s not an option,” she said. “Because it’s not evidence-based, and it’s not best in care.”
The hospital association has measurable goals to bring its members along and help educate their patients, said Elizabeth Cobb, the hospital association’s vice president of health policy.
Dangerous trend
Between 1990 and 2006, the national rate of elective labor inductions jumped from 9.5 percent to 22.5 percent, according to
publications from The Leapfrog Group, a nonprofit dedicated to reducing early deliveries.
Researchers blame several factors. Women incorrectly believe it’s safe to deliver as early as 36 weeks; hospitals have developed a culture of encouraging this practice; and doctors sometimes make more money by scheduling deliveries, the Leapfrog Group reports.
Cobb added that technology has made it seem safer.
“I think that we take those risks for granted, maybe, because hospitals are providing such exceptional care,” she said.
But the risks remain serious. Women induced in the 37th or 38th week have higher risks of needing cesarean sections, which can lead to additional cesarean sections with increasing dangers, the Leapfrog Group reports.
Early deliveries more often produce bleeding and wound problems, anemia, endometriosis and urinary tract infections, studies have shown. Babies born early have higher rates of mortality and disease, respiratory problems and placements in intensive care, according to a 2009 obstetrics study.
Early delivery often means more hospital time for mothers and babies.
Trover’s experience
Trover started in 2010 its CenteringPregnancy program, which aims to get women more involved in their own prenatal care. Trover staff re-examined the whole paradigm of treatment and sought ways to use more evidence-based care.
In 2010, Trover changed its policy on early deliveries: It would only use them when there was a compelling reason, such as safety. Convenience didn’t count.
“It was a pretty staunch, or hard-stock, approach that we took,” Langston said.
But staff members were ready for the change because they already had an innovative mindset, Langston said. And new mothers adapted when doctors and nurses explained their reasons.
Now, from her first visit with a Trover obstetrician, the woman starts learning about brain development and the importance of a full-term pregnancy. She learns every week counts.
A tough transition?
The Kentucky Hospital Association started a quality improvement program earlier this year. It’s part of a national endeavor to reduce hospital-acquired conditions by 40 percent and readmissions by 20 percent before 2014.
In Kentucky, 101 hospitals are participating, Cobb said.
One of the program’s 10 focus areas is obstetrics-related harm, especially from early deliveries, Cobb said.
The hospital association is using a toolkit that the March of Dime publishes. The toolkit played a crucial role in Trover’s conversion, Langston said. It involves changing hospital policies, educating hospital staff about risks of early deliveries, and educating patients.
All the hospitals are submitting numbers each month, Cobb said.
Jennie Stuart just submitted base-line statistics last month. Staff members are still determining how they’ll make the changes, spokesman James Goss said.
The Trover team schedules a conference call every month. Hospital staff all over the state can compare notes on how they’re progressing.
It can be a tough transition, like ripping a Band-Aid off, Langston said. So it reflects well on nurses and doctors who are participating.
“I think the hospitals who select this measure are a lot like us, and they’re very proactive about improving outcomes,” Langston said.

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