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39 Weeks Hospital Initiative

In February 2014, OHA announced a comprehensive and targeted plan to reduce Ohio's infant mortality rate five percent annually over the next three years. The 2014-2016 strategic plan includes seven specific areas of focus for infant mortality. The safe sleep initiative launched in April 2014, with nearly 100% participation by Ohio's pediatric and maternity hospitals. The next step in OHA's strategic plan is to continue to reduce Ohio's decreasing rate of early elective delivery by participating in this 39+ Weeks initiative. For more information about this initiative, see OHA's White Paper on Reducing Early Elective Deliveries.


We encourage hospitals to participate in this statewide campaign by engaging in the following steps:

Designate a Champion & Complete Baseline

  • Designate a 39+ Weeks Champion
Complete this form to designate a hospital 39+ Weeks Champion.
 
  • Complete the Baseline Assessment & Order Pins
After completing this short survey, you will be able to order your hospital's complimentary lapel pins to show participation in this statewide initiative.
 

Standardize the Process

  • Evaluate Scheduling Process
Implement a new or revised induction scheduling and informed consent process that includes rationale for elective deliveries. (see sample policies page)

Consider integrating a "Hard Stop" for scheduled deliveries prior to 39 weeks gestation.

Provide training for physicians, nursing staff and schedulers about the new/revised policy. (see staff training resources)

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Promote Transparency & Accountability

  • Provide Transparency

Meet with risk management, quality and/or safety officers. Highlight the importance of data collection and analysis. Emphasize the significance of accurate internal data validation, providing a thorough understanding of provider documentation, coding practices and collaboration with coders.

Track and trend elective deliveries prior to 39 weeks gestation.

Collect less than 39 week elective data for every practitioner utilizing clear definitions such as those from National Quality Forum (NQF)-NQF# 0469, Joint Commission-PC-01 Elective Deliveries, Leapfrog, or Partnership for Patients Maternity Care/Obstetrical Adverse Event.

Provide transparent hospital-level data to leadership, medical staff and other engaged providers and stakeholders.

Share best practices within the hospital, health system, region and state.

Reinforce hospital's commitment with visual aids, such as posters and lapel pins. (March of Dimes' materials and lapel pins)

  • Promote Accountability
Work with medical staff to develop and adopt Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) policies and procedures. (see sample policies)
 
The process for OPPE should be clearly defined and put in place to facilitate the evaluation of each practitioner’s professional practice; including advance practice nurses (APNs), midwives, and physician assistants (PAs)

Train staff and physicians on new policies to enable and empower nurses and clerical staff to enforce policy. (see staff training resources)

Include improvement activities in measures for performance-based privileging of physicians.

Audit the hospital's implementation and enforcement of OPPE/FPPE policies.

Provide transparent physician-level data to leadership, medical staff and other engaged providers and stakeholders.

Encourage peer to peer discussions regarding the importance of eliminating early elective deliveries.

Educate Staff & Physicians

  • Educate Staff

Train coders and birth certificate clerks in documenting accurate neonatal age. (OPQC training tools)

Educate staff on new policies and the importance of eliminating early elective delivery. (see staff training resources)
 

  • Engage Physicians
Provide education on the detrimental effect of EED to both infant and mother, and provide a simple culturally-sensitive summary of evidence from literature. (see resources and research section)

Share policies and information with outpatient providers' offices to reinforce information among clinicians and office staff. 

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Provide Consumer & Community Education

  • Inform the Consumer

Enlist childbirth educators to inform women and families, during hospital tours or childbirth education classes.

Enlist office staff of outpatient providers to provide counseling and print materials to expectant moms. (see patient education resources)

Ensure documentation of informed consent discussions with patients in the medical record, to ensure that women are aware of the risks of early elective delivery.

Counsel women contemplating elective induction at or beyond 39 weeks’ gestation with an unfavorable cervix regarding an increased rate of cesarean delivery.

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