Decrease in Cervidil use for cervical ripening by 20% of anticipated doses prior to Dec 1, 2018 (6 mos) , with a potential for cost savings = 40 doses x approx. $2000/dose = $80,000

Abbott, Zander

Austin, Sarah

Dumais, Colette

Morin, Heidi

Pinette, Michael G

Sepulveda, Deb

Tarraza, Hector

Tkacz, Maria

English

MaineHealth Knowledge Connection

MaineHealthMaineHealth Knowledge ConnectionMaine Medical Center All MaineHealth10-8-2018Cervical Ripening for Induction of LaborDeb SepulvedaMaine Medical CenterMichael G. PinetteMaine Medical CenterHeidi MorinMaine Medical CenterColette DumaisMaine Medical CenterSarah AustinMaine Medical CenterSee next page for additional authorsFollow this and additional works at: https://knowledgeconnection.mainehealth.org/mmcPart of the Pharmacoeconomics and Pharmaceutical Economics CommonsThis A3 is brought to you for free and open access by the All MaineHealth at MaineHealth Knowledge Connection. It has been accepted for inclusionin Maine Medical Center by an authorized administrator of MaineHealth Knowledge Connection. For more information, please contactmckeld1@mmc.org.Recommended CitationSepulveda, Deb; Pinette, Michael G.; Morin, Heidi; Dumais, Colette; Austin, Sarah; Tarraza, Hector; Tkacz, Maria; and Abbott,Zander, "Cervical Ripening for Induction of Labor" (2018). Maine Medical Center. 552.https://knowledgeconnection.mainehealth.org/mmc/552AuthorsDeb Sepulveda, Michael G. Pinette, Heidi Morin, Colette Dumais, Sarah Austin, Hector Tarraza, Maria Tkacz,and Zander AbbottThis a3 is available at MaineHealth Knowledge Connection: https://knowledgeconnection.mainehealth.org/mmc/552Project: Cervical Ripening For Induction Of  Labor  Last Updated:  October 8, 2018   Countermeasures Outcomes Over the past twelve months, 58% (or 340) of patients requiring cervical ripening prior to induction of labor were managed with Cervidil. 401 doses were administered, at a cost of $2,214 per dose, for total charges of approximately $887,000.  Alternative methods for cervical ripening, often clinically appropriate, range from $2.73 to $180. Problem/Impact Statement: In scope (metric): Patients requiring cervical ripening for induction. Time frame from admission for induction to delivery. Out of scope: Not requiring ripening (dilated >6cm).   In scope (intervention): Physicians and staff. Out of scope: Direct patient education.   Scope: Decrease in Cervidil use for cervical ripening by 20% of anticipated doses prior to Dec 1, 2018 (6 mos) , with a potential for cost savings = 40 doses x approx. $2000/dose = $80,000.   Goal/Objective: Disparity in practice between seven practice groups with range in Cervidil use – ranging from 26% - 87% of cases. Range 50% to 4% use of very low risk, affordable mechanical ripening (balloon/foley).   Disparity examples: Use of  approaches by two groups: Baseline Metrics/Current State: • RCA based on survey of physicians, discussion with staff:    • “5 Why” summary:         Discrepancy in Cervidil use between groups – Why?             Preferential use by some providers – Why?                 Perceptions varied (re: cost, efficacy, staff required,                       weight given to convenience and comfort) – Why?                     Lack of education re: cost                    No local data reported                    Lack of standardized algorithm                    Need for clarity re: staffing required Root Cause Analysis: Next Steps Executive Sponsor: Zander Abbott MBA   Facilitator: Deb Sepulveda MD MPH Plan Do Study Act Team Members: Deb Sepulveda MD MPH, Mike Pinette, MD, Heidi Morin, RN, Colette Dumais, RN, Sarah Austin, RN, Hector Tarraza, MD, Maria Tkacz, MHA 69 56 51 65 81 32 31 28 13 Jan Feb March April May June July Aug SeptDoses of Cervidil as a Percent of Patients with Cervical Ripening 58000 70000 46000 60000 96000 34000 36000 30000 24000 Jan Feb March April May June July Aug SeptCervidil, Approximate Charges • Practice feedback for Cervidil now integrated into Performance Improvement Committee • FY ’19 transformation focus on inductions  • Algorithm posted on Obstetrical Guidelines webpage for access by other institutions   $136,000 extrapolated “charge savings” over 4 months 

Cervical Ripening for Induction of Labor

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Cervical Ripening for Induction of Labor

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