Reducing Elective Early-Term Deliveries: One Hospital’s Groundbreaking Optimization Work

St. Marie: From the IT perspective, once we got the software, the codes able to run to do the analysis, we were able to reuse that every month, and we’re able to print out a monthly report that Dr. Healy presents at grand rounds, and that is re-created in comparison with previous months. And in a few hours, we’ve analyzed all the deliveries for the month, and have specifics on inductions, elective inductions, etc.; and the only way we’re able to do that is because we can query PeriBirth; and I use software that does ODBC queries, to talk to the server.

Grow: So what’s very useful are the quarterly visits from PeriGen that have a standard report of about 100 quality metrics that we can track internally, and so one of them is frequency of blood transfusion; another is frequency of third- and fourth-degree episiotomy; another is frequency of perfect documentation from our nursing team. So we get that quarterly and get benchmarking across every organization that uses PeriGen. They have approximately 400,000 deliveries in their database; I think there are about 30 other organizations using it.

This is part of the broader shift towards evidence-based, consensus-driven, medical practice, isn’t it?

Healy: I would agree that there’s definitely a movement towards evidence-based care, and that’s been going on for a while now. There are two things I would stress: first, you need to be able to establish the evidence, and systems like PeriBirth do that. And second, you need to be able to measure deviations against standards of care; and again, PeriBirth does that, and you need to be able to address who is deviating, and address that.

St. Marie: And PeriBirth is our inpatient OB EMR; and the hospital has a separate EMR for everyone else. That is not as easy to query, as the data in that database is not updated as frequently as the PeriBirth data. With PeriBirth, I can get data for patients still in the hospital and orders just placed. With the inpatient EMR, it’s nearly historical data, and requires a much more difficult, proprietary method. So that’s the great thing about PeriBirth for me; I can write a few lines of code to address a query, and have the information back to them within a half-hour.

Healy: And once an acceptable standard has been established, we can use PeriBirth for that purpose. What is the correct dosage for a particular medication in a particular situation, for example? Standardizing care is very important.

Grow: And in this study, putting this policy in place, hard stops for induction of labor, reduced our NICU admission rate significantly, for patients over 37 weeks gestation, from 3 percent to 2 percent, so a reduction of a third. So the NICU admission rate dropped by over a third in that group.