You probably have been involved in many efforts to eliminate early-term elective births over the past several years. These efforts may have included healthcare provider and patient education, unit "hard stops," and hospital and healthcare system policies. If you care for women in labor, you likely have had one or more unpleasant conversations with providers and/or patients about the need to be 39 completed weeks before an elective birth can be performed. You may have participated in programs presented by the March of Dimes Foundation and the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), and your unit's practices may have been scrutinized by the Joint Commission and others. You probably have posters from AWHONN's 40 Reasons to Go the Full 40 (2012) campaign in patient areas and the March of Dimes Foundation, California Maternal Quality Care Collaborative, and California Department of Health, Maternal Child and Adolescent Health Division (2011) Less than 39 Weeks Toolkit on your unit. Practice bulletins, committee opinions, and position statements from the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives have likely been discussed at department meetings. Your hospital and/or healthcare system may be participating in a quality improvement collaborative or hospital engagement network to work together with others on this issue.

With all of this activity and energy by so many national organizations and leaders, it may seem that early-term elective births are no longer occurring in the United States. However, despite momentum in the right direction and significant decreases in the last few years, early-term elective births remain a problem in some areas. The Centers for Medicaid and Medicare Services (CMS, 2014) report that there are wide variations among states' rates of early elective birth: from 2% to 22%. Variations also are noted within states; for example, in some states with low rates, there are individual hospitals with high rates (CMS, 2014).

To assist caregivers, hospitals and healthcare systems having challenges in eliminating elective early-term births, the National Quality Forum (NQF) convened the Maternity Action Team (MAT) comprised of clinicians and leaders in maternity care and quality improvement to develop strategies to promote success. Representatives of the key professional organizations, including AWHONN, were invited to participate in a year-long effort, which resulted in the publication on August 18, 2014, of the Playbook for the Successful Elimination of Early Elective Deliveries (NQF MAT, 2014). If your hospital is struggling with this issue, take the time to review this resource. Key information provided includes how to overcome barriers to reducing early elective births, challenges in monitoring performance, measurement guidance, lists of resources for childbearing women and clinicians, and instructions for using the CMS Hospital Compare Inpatient Quality Reporting (IQR) program. This is a practical resource with helpful solutions developed by those who have been working on this important clinical issue for many years. I'm sure you will find some aspect of the Playbook that will be useful in your practice.

* Review the Playbook for the Successful Elimination of Early Elective Deliveries (NQF MAT, 2014)

* Use the strategies suggested to achieve success

* Access the CMS Hospital Compare Inpatient Quality Reporting (IQR) program to see how hospitals in your area are doing on this important safety issue

* Share the Playbook with others

References