October 22nd, 2014

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Title:
Does Enhanced “Bundling” Criteria Improve Outcomes? A Comparative Study of Elective Inductions
Authors:  Tiffany H. Kenny, M.S.N., Jacqueline M. Nicodemo, Bradford W. Fenton, M.D., Ph.D., and Vivian E. von Gruenigen, M.D.
  OBJECTIVE: To assess outcomes and costs of dyads achieving elective induction bundle criteria with a favorable Bishop score.

STUDY DESIGN: In a historical automated records-based cohort study, 180 dyads undergoing elective induction bundling at a single institution from 2009 to 2010 were compared to a pre–introduction of bundling cohort. The bundled cohort was then compared by Bishop score.

RESULTS: The bundled cohort (n=180) had a lower cesarean delivery rate (12% vs. 21%, p=0.01), but neonatal special or intensive care admissions were not statistically significant compared to the pre–introduction of bundling cohort (n=473). Ninety-six percent (n= 173) of the bundled cohort achieved bundle criteria. Those with a Bishop score >6 (52%, n=90) had fewer cesarean deliveries (4% vs. 19%, p=0.003), fewer neonatal special or intensive care admissions (1% vs. 10%, p=0.015), shorter induction time to vaginal delivery (8.8 vs. 17 hrs, p<0.001), fewer cesareans for dystocia (75% vs. 94%, p=0.002) or fetal heart rate abnormalities (25% vs. 50%, p=0.015), and had one-sixth the average net income lost ($423 vs. $2,600, p<0.001) compared to bundle achievers with a Bishop score of ≤6.

CONCLUSION: The elective induction bundle does not guarantee quality and should require favorable cervix instead of documented Bishop score to proceed with induction.
Keywords:  Bishop score, bundle, elective induction, healthcare reform, induced labor, perinatal care, reference standards, standardization
   
   
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