226315 Reducing elective labor induction in San Bernardino County: A public health and hospital maternal health quality improvement partnership

Tuesday, November 9, 2010

Jennifer Baptiste-Smith, MPA , Department of Public Health; Maternal, Child and Adolescent Health Section, County of San Bernardino, San Bernardino, CA
Maxwell Ohikhuare, MD , Department of Public Health, County of San Bernardino, San Bernardino, CA
Lony Castro, MD , Department of Obstetrics and Gynecology, Western University of Health Sciences, Pomona, CA
Bryan Oshiro, MD , Department of Obstetrics and Gynecology; Maternal Fetal Medicine, Loma Linda University School of Medicine, Loma Linda, CA
Stewart Hunter , Department of Public Health; Maternal, Child and Adolescent Health Section, County of San Bernardino, San Bernardino, CA
David Yleah, MPH, CHA , Department of Public Health; Maternal, Child and Adolescent Health Section, County of San Bernardino, San Bernardino, CA
Background: Elective labor induction, especially prior to 39 weeks gestation, appears to increase maternal morbidity and mortality. San Bernardino County experiences both the highest rate of maternal mortality (18.0 per 100,000 live births) and labor induction (18.35% of total births) in California (2006). Countywide, first time mothers face a 1 in 5 chance of being induced; this risk increases to 1 in 4 in low-risk mothers.

Objectives: To reduce pregnancy-related morbidity and mortality by decreasing the rate of elective labor inductions occurring in pregnant women residing in the County to 15%, the ACOG quality benchmark.

Methods: The public health department provided leadership to convene partners from the medical, health education and community arenas to develop common clinical guidelines, a toolkit and data collection methods.

Results: Project accomplishments: Labor induction toolkit/guidelines developed and distributed to 17 partner hospitals. Education forum attended by 50 clinicians. Quality improvement data collection from 13 hospitals. Neighboring health jurisdictions have requested implementation guidelines.

Findings: Many hospitals lack and/or need: Effective systems to collect and report labor induction data and differentiate elective from non-elective procedures. Induction policies, guidelines, and procedures for hospitals and physicians. Improved knowledge of Joint Commission labor induction core measures

Conclusion: Public health departments can lead patient safety initiatives and engage local hospitals to develop policies to improve the quality of maternity care.

Learning Areas:
Administer health education strategies, interventions and programs
Advocacy for health and health education
Basic medical science applied in public health
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Provision of health care to the public

Learning Objectives:
1. State three reasons pregnant women choose to undergo an elective induction. 2. Describe current benchmarks regarding labor induction. 3. Summarize how elective labor induction impacts the health of mothers and infants. 4. Describe two strategies the County has undertaken to decrease labor induction.

Keywords: Maternal Health, Labor

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Jennifer serves as the Program Manager at the County of San Bernardino, Department of Public Health, MCAH Section.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.