Not all pregnant women have the same definition of “full term.”
Many women accept the long-held belief that 37 weeks – a little more than nine months – is the normal term for a pregnancy and schedule delivery accordingly.
But research into infant brain development, feeding habits, and overall health have led doctors in recent years to recognize 39 to 40 weeks as an “at-term” pregnancy, and to point to elective delivery before that period as risky for the baby‘s growth.
MultiCare physicians and nurses are no different: Thanks to the efforts of the Women‘s Collaborative OB/GYN Work Group, which has focused on educating patients and standardizing policies and procedures, the elective delivery rate at MultiCare facilities has remained at or near zero this year.
The reduction in elective deliveries before 39 weeks is just one of the successes of the Women‘s Collaborative, one of six clinical collaborative efforts among medical and administrative personnel from facilities around the MultiCare Health System.
Tasked with identifying ways to streamline care, improve patient outcomes and reduce costs, the collaboratives – Critical Care, Surgery, Cardiac, Medicine and Women‘s – are divided into work groups that drill down to the day-to-day delivery of health care.
By targeting needs, collecting data, and, in many cases, changing routines and processes, efforts such as the OB/GYN Work Group are demonstrating ways to enhance and streamline the patient experience systemwide.
The OB/GYN Work Group started by identifying specific areas, such as episiotomies, in which data collection and analysis, as well as procedures, could be improved, said Dr. Steve Poore, an obstetrician/gynecologist at MultiCare Tacoma Women‘s Specialists and a leader of the Work Group.
Inconsistencies in data collection and tracking, in particular, he said, revealed where the group should put its emphasis. Better data systems, plans for improving care, and now, a digitized, timely method of feedback to doctors all contribute to lower costs and better patient outcomes.
“You need a process to pull accurate information; that‘s what this has taught us,” Dr. Poore said. “We have systemized the process within several hospitals, enhancing the accuracy so that our reporting numbers will be more reflective of good care we‘re doing.”
Over time, the Work Group‘s efforts expanded to include a decrease in the elective delivery rate, processes for high-BMI pregnant patients, promotion of breastfeeding to all new moms and guidelines for the “perfect hysterectomy.”
Standardizing pathways for hysterectomies, Dr. Poore said, involved first reviewing data to learn where inconsistencies were occurring, and what costs were not being reimbursed by insurers due to missing paperwork, for example. Then the Work Group turned to “break down the patient experience from A to Z,” Dr. Poore said.
With an emphasis on robotic hysterectomies – an outpatient procedure – MultiCare can lower inpatient costs while providing an appropriate and efficient level of care. Now, he said, approximately 95 percent of hysterectomies at MultiCare are minimally invasive procedures – exceeding national data, which shows that abdominal (inpatient) hysterectomies make up more than half the procedures performed.
“Once the patient realizes that‘s the expectation, then you‘re meeting the expectation, and that‘s a satisfied customer,” Dr. Poore explained. “The perfect hysterectomy should be exactly that: Everything is in its place at the right time.”
The Work Group‘s focus on reducing elective delivery rates also reflects a larger trend in health care, said Karen Baker, a nurse at MultiCare Good Samaritan Hospital in Puyallup.
Over the past three years, both the Washington State Hospital Association and the Centers for Medicare & Medicaid Services have pushed facilities to limit elective inductions before 39 weeks. So MultiCare‘s Work Group brought together representatives from three hospitals with delivery services – Auburn Medical Center, Good Samaritan and Tacoma General – to come up with a plan.
Changing a practice meant educating both patients and providers alike, said Baker, a member of the Work Group. For example, patients now learn more about the induction process, how early induction can impact a baby‘s health, and how it often results in a C-section. Hospitals no longer schedule an elective delivery unless the patient has reached 39 weeks and meets other physical criteria.
As with any effort involving multiple stakeholders, it took a little time for doctors and nurses at all three hospitals to follow the same procedures. But today, the data demonstrate the impact.
“The importance of the Collaborative is that we have all these different hospitals, and we‘re trying to standardize our practice, looking to bring best practices to all three facilities,” Baker said. “It‘s helped us become more of a system than three separate entities.”