This article describes how a program aimed at reducing elective inductions was successfully implemented and sustained in a large community hospital — Swedish Medical Center, a participant in IHI's Improving Perinatal Care Collaborative.

Reisner DP, Wallin TK, Zingheim RW, Luthy DA. Reduction of elective inductions in a large community hospital. Am J Obstet Gynecol. 2009 Jun;200(6):674.e1-7. Epub 2009 Apr 18.

The goal was to lower unplanned primary cesarean deliveries by reducing elective inductions. To implement and sustain an induction management program, a committee of care providers reviewed induction rates; "elective" and other categories were defined; an induction consent form was drafted; and consent compliance, induction rates, hours in labor and delivery and mode of delivery were evaluated. Outcomes were compared with historical data from 2 years earlier. Elective inductions decreased significantly, from 4.3% to 0.8% in nulliparas and from 13% to 9.5% in multiparas. A longer time to delivery was seen for both nulliparas (5.2 hours) and multiparas (4 hours) with elective inductions. Unplanned primary cesarean delivery rates are significantly lower in spontaneously laboring women, compared with those induced.

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