New guidelines to reduce early elective deliveries cut NICU admissions by 50%

Winnie Palmer Hospital for Women & BabiesMay 16 2013

New guidelines to reduce early elective deliveries (EED) at Winnie Palmer Hospital for Women & Babies have cut by 50 percent the admission of late pre-term newborns (37-38 weeks gestation) into the neonatal intensive care unit (NICU), resulting in healthcare cost savings.

Working with the March of Dimes and the Florida Perinatal Quality Collaborative, Winnie Palmer Hospital instituted new guidelines aimed at reducing EED for non-medical reasons prior to 39 weeks gestation. In January 2012, the following guidelines were implemented:

•A new scheduling tool and enhanced training designed to help delivery schedulers prevent deviations in standard of care
•A hard stop for any EED that did not meet acceptable criteria
•Induction consent with patient education on associated risks
•Establishment of protocol for EED that meet acceptable criteria
•Development of protocol for inductions at 39-41 weeks gestation

The results have been dramatic for the country's second-busiest labor and delivery hospital. Since initiation of the guidelines, EEDs for non-medical reasons at Winnie Palmer Hospital have decreased to below seven percent of all deliveries consistently, highlighted by two months below three percent. The changes have resulted in better care for infants and their mothers and a decrease in NICU admissions of 37- and 38-week gestation newborns. In 2012, 46 late pre-term newborns out of 13,856 deliveries were admitted into the NICU, compared with 81 out of 12,978 deliveries in 2011. This resulted in a cost savings to the community of nearly $1 million.

"We know that delivering a baby for non-medical reasons before the mother reaches her 39th week of pregnancy can be very harmful to newborns and potentially require more care for mothers," says obstetrician Jose Gutierrez, M.D. "It has physiological and developmental impacts on the baby, and it definitely impacts the cost of healthcare because of the additional care that's needed for the baby and the mother."

A developing baby goes through important growth during the final weeks of pregnancy. Many organ systems, including the brain, lungs, and liver need the final weeks and days of pregnancy to develop fully.

"Newborns delivered prior to 39 weeks gestation have not had sufficient time in the womb to fully develop those vital organs and are often affected by a number of respiratory conditions, vision and hearing problems, difficulty sucking and swallowing, and staying awake long enough to breastfeed," says neonatologist Jose Perez, M.D. "Babies impacted by these conditions will certainly face prolonged hospitalization in the NICU and lose the opportunity to have that precious skin-to-skin contact with the mother after delivery."

As the first phase of guidelines to reduce EEDs moves forward successfully, Winnie Palmer Hospital continues to identify other opportunities for sustainable improvement in newborn outcomes and reduced healthcare costs. It represents how Winnie Palmer Hospital and the other hospitals in the Orlando Health family are allowing patients and their health drive clinical decision-making.