May 28th, 2018

A full text version of this article is available.
To access article obtain online access here or login
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
  Acrobat Reader 7.0 is recommended to properly view and print the article.
Reader can be downloaded from