Labor induction process improvement: a patient quality-of-care initiative

Obstet Gynecol. 2009 Apr;113(4):797-803. doi: 10.1097/AOG.0b013e31819c9e3d.


Objective: To examine the effects that medical staff education and a new process for scheduling inductions had on decreasing inappropriate inductions.

Methods: At our institution in 2004, guidelines were developed and shared with the medical staff and reinforced in 2005. The guidelines for elective induction required patients to have completed 39 weeks of gestation and to have a Bishop score of at least 8 for nulliparas and 6 for multiparas. In 2006, the induction scheduling process was changed and the guidelines were strictly enforced. All scheduled inductions during the same 3-month time period (June through August) in 2004 (n=533) and 2005 (n=454) and during a 13-month period from November 2006 to December 2007 (n=1,806) were compared. Outcomes included elective inductions less than 39 weeks, cesarean birth rate for elective inductions among nulliparas, and the overall induction rate.

Results: From 2004-2007, the overall induction rate dropped from 24.9% to 16.6%, a 33% reduction(P<.001); the elective induction rate dropped from 9.1% to 6.4%, a 30% reduction (P<.001); the percentage of elective inductions before 39 weeks of gestation dropped from 11.8% to 4.3%, a decrease of 64% (P<.001); and the frequency of cesarean delivery among nulliparas undergoing elective induction dropped from 34.5% to 13.8%, a decrease of 60%. (P=.01).

Conclusion: Medical staff education and the development and enforcement of induction guidelines contributed to a decrease in inappropriate inductions, a lower cesarean birth rate for electively induced nulliparas, and a lower elective and overall induction rate.

Level of evidence: III.

MeSH terms

  • Adolescent
  • Adult
  • Appointments and Schedules
  • Cesarean Section / statistics & numerical data*
  • Female
  • Gestational Age
  • Guideline Adherence*
  • Humans
  • Infant, Newborn
  • Labor, Induced / adverse effects
  • Labor, Induced / standards*
  • Middle Aged
  • Obstetrics / education*
  • Obstetrics / standards*
  • Parity
  • Practice Guidelines as Topic
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy Trimester, Third
  • Quality of Health Care*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Young Adult