EFFECTS OF ELECTIVE DELIVERY POLICY ON CLINICAL AND COST OUTCOMES

The United States is an increasingly attractive location for foreign mothers to deliver their babies. At one southern California medical center, many foreign mothers with late local third trimester prenatal care demanded early delivery (e.g., less than 39 weeks gestation). This led to increased numbers of infants admitted to the Neonatal Intensive Care Unit (NICU), reflecting potentially poor fetal outcomes and uncompensated costs for the facility. The hospital implemented a new elective delivery policy based on American Congress of Obstetricians and Gynecologists (AGOG) recommendations. During 2012, a team was formed to manage the processes, which included educational sessions and dissemination of the new policy to the medical and nursing staff. An evaluation that compared monthly numbers of scheduled early elective deliveries in 2011 to 2012 were compared to those from 2013 to 2014. Prior to the policy implementation, 277 elective delivery cases did not comply with ACOG recommendation standards (16% of all deliveries) compared to eight cases (0.4%) after policy implementation; 39 NICU admissions occurred prior to the implementation compared to three admissions afterwards. Uncompensated hospital costs dropped from $254, 546 pre-policy to $0 afterwards. These results indicate that the successful implementation of the policy promoted the safety and health of mothers and neonates, and decreased uncompensated costs for the hospital. Staff morale also increased due to pride in following ACOG recommendations and perceptions of enhanced neonatal safety