1. Elective Induction “A Maternal Safety and Quality Care Issue”

2. What?  Elective Inductions Prior to 39 wks –Poor practice and should not be done.  Elective Inductions After 39 wks –Associated with an increased risk of C-section –Associated with an increased time in Labor and delivery –Has increased from 9% to 19% from 1989-1998 in the U.S. (21% at PCMH in 2007)

3. Why?  Patient Convenience  Physician Convenience  Patient flow (19 hrs vs 12 hrs) ****  Increased C-Section Rate (35% vs 17 %)

4. Who?  Nursing  Hospital Administration  Physicians  Patients ***

5. Where?  Starts in the Clinic  Extends to Labor and Delivery  Effects Anesthesia and OR  Effects Post-Partum and Ante-partum units  Effects NICU  Returns to Clinic

6. How? (The Five T’s)  Track – Track all inductions and indications (Hawthon Effect)  Triage - all induction posting via a single RN (Women’s Service Facilitator).  Talk - Make known to all (patents and physicians) the Prioritization of admission.  Telephone – Have all patient’s posted for induction call Labor and Delivery prior to leaving the house  Thank – Thank them for their patients and understanding

7. Thank You