Lessons Learned from the Florida Big 5 Hospitals Efforts to Eliminate Non-medically Indicated Deliveries <39 Weeks Gestation

Published guidelines (ACOG 1979) advise against non-medically indicated (NMI) deliveries before 39 weeks gestation due to increased risk of neonatal mortality and morbidity. Six Florida hospitals participated in the March of Dimes Big 5 Hospital Network to pilot test a toolkit to eliminate such deliveries. Evaluation of the pilot included two interviews with each hospital team on implementation challenges and successes. Phone interviews were conducted with hospital teams at six months post-implementation and at the end of the yearlong pilot. Interview topics included data collection and use, physician/nurse leadership, barriers to system change, project challenges/successes, and hospital demographics. Questions were provided to hospitals prior to the interviews to enhance response quality. Answers were captured in written notes which were summarized and circulated to the interviewers to assure accuracy and completeness. Interview data from all hospitals was sorted and consolidated by question and assessed for recurring themes and diversity of responses. Support from project physician leaders, empowerment of nurses, and timely communication of data, and understanding differing needs of large and small hospitals were critical to successful implementation. Barriers to system change included physician resistance, efforts to work around the policy, and completing deliveries scheduled prior to policy change. Successes included fewer babies transferred to the NICU and more women arriving at the hospital in natural labor. Lessons learned from the Florida Big 5 pilot hospitals can help guide efforts to eliminate NMI deliveries in other hospitals via distribution of a list of anticipated barriers and strategies to address them.