1. Data Results: Early Elective Deliveries September 17, 2012

2. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 2 Where did we start? CMS and the National Content Developer charged all HENs to reduce HAC’s by 40% Adding reducing readmissions by 20% Finally adding reducing EEDs by 40%

3. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 3 Who helped us start? Buy-in from hospitals March of Dimes Department of Public Health Georgia Chapter of OBGYN Society Georgia Chapter of the Society for CNM Georgia Nurses Association AmeriGroup And others

4. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 4 How did we start? EED Action Group met in April 2012 to review 2009 data regarding EED Developed and agreed upon plan to reduce EED’s by 40% – Ultimate overall goal for Georgia: 0% – Timely goal for August 2012: 5% or less Plan: Encourage use of “hard stops” or IHI bundles to empower nurses and schedulers

5. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 5 EED Action Group

6. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 6 The Journey In-person meeting inviting all birthing hospitals in Georgia – March of Dimes – Department of Public Health – WellStar Health System – Athens Regional Health System – Liberty Medical Center Pledge was signed to reduce EEDs across Georgia Telnets/Webinars and one-on-one calls with hospitals were held including subjects on physician engagement, hard stops, risks to moms and babies and more!

7. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 7 Commitment Poster signing

8. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 8 Commitment poster signing 2

9. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 9 The Journey Several hospitals shared their success in reducing EED’s – Atlanta Medical Center – Emory University Midtown – Piedmont Henry

10. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 10 The Results There are 75 birthing hospitals in Georgia 57 (77%) of those hospitals turned in data 19 (33%) of the 56 hospitals were already at a 0% EED rate Of the 38 hospitals needing improvement about ½ showed significant gains!! 3 of those hospitals went from a 14% or higher EED rate to a 0% rate sustained for at least 3 months!!

11. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 11 The Results 1 2009 – 65% 2010 – 56.7% August 2012 – 3.62% YTD 2012 – 5.98% That’s a 93% decrease in Early Elective Deliveries!!! For YTD that’s a 90% decrease!!

12. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 12 The Results 2 From March 2012 baseline data to August 2012 data: – We can celebrate a 56% decrease in EEDs

13. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 13 The Results 3 According to Managed Care Magazine it costs around $41,000 for a late preterm NICU visit The incidents went from 147 incidents in March 2012 to just 30 in August 2012 That’s a decrease of 117 incidents If even a ¼ of the babies went to NICU, we saved Georgia Healthcare $1,199,250.00 OVER 1 MILLION Dollars!!

14. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 14 The Results 4

15. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 15 The Results 5

16. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 16 The Results 6

17. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 17 Lessons Learned Important to work as a team Get physician buy-in and have a physician champion Empower your schedulers and nurses Have a peer review for non-medically necessary EED Educate patients early starting at first visit Collaborate with others even outside your hospital: – Share best practices – Share forms – IHI – March of Dimes

18. Learn. Act. Improve. Spread. Keep the Drum Beat Going. 18 Lessons Learned 2 Use data to sustain the gain Present data to administration and physicians Celebrate your success!!!

19. Questions??