Non-spontaneous, or scheduled delivery of an infant prior to term gestation is sometimes required to avert maternal and/or infant morbidity or mortality. However, a variable fraction of scheduled deliveries prior to 39 weeks gestation appear to be elective, and potentially expose late preterm and near-term infants to increased neonatal, infant and lifetime morbidity compared to infants born at term. This project seeks to reduce early elective delivery before 39 weeks gestation while ensuring deliveries to avert maternal and infant morbidity continue as needed.

This project was completed in 3 phases. A small scale pilot project was completed under the leadership of Dr. Frank Boehm in Davidson county in 2009-2010. All Davidson county hospitals with delivery services participated and demonstrated a reduction in their early elective delivery rate prior to 39 weeks gestation. Subsequently hospitals in Hamilton, Jackson, Maury and Shelby counties were asked to join the Davidson county hospitals to test the spreadability of the project. The Davidson county hospitals were able to sustain their reduction in early elective deliveries and the new hospitals demonstrated they were able to achieve similar reductions by the close of 2011.

The 39 Week Elective Delivery Reduction project began statewide spread in May 2012 in collaboration with the Tennessee Hospital Association’s (THA) Hospital Engagement Network (HEN) using the Joint Commission’s Perinatal Core Measure 1. In October 2012, a letter from the Tennessee Department of Health (TDH), THA, March of Dimes (MOD), and TIPQC was sent to all hospitals CEOs encouraging adoption of a “hard stop” policy to eliminate Early Elective Deliveries, and included a public commitment pledge, which 54 hospitals signed. The “Healthy Babies Are Worth the Wait” public awareness Campaign sponsored by the MOD, THA, TDH and TIPQC began in November 2012 with a goal of helping the public better distinguish medically necessary from elective deliveries prior to 39 weeks completed gestation. All 66 delivery hospitals in Tennessee hospitals have participated in the joint TIPQC, THA, TDH, MOD project and have reduced the statewide aggregate early elective delivery rate prior to 39 weeks to less than 5%. Provisional project improvement data at right courtesy of the Tennessee Hospital Association’s Tennessee Center for Patient Safety.