Re: 66% Induction Rate
From: Efrain Ramirez (eramirez@icepr.com)
Wed May 30 08:10:14 2001
"any induction" 0% failure rate? - I don't think that's completely
accurate - the figures I've seen varied a lot depending on Bishop scores
elective vs. indicated, primis vs multips - from 0 point something to
20% -
At Wed, 30 May 2001, Vik wrote:
>
>Any induction carries with it a %30 failure rate leading to cesarean
>section and of course the morbidities that entails, if this MD did 66%
>inductions and had the %30 failure rate then if he had 100 deliveries a
>year at his induction rate he would have 22 c/sxn from failed
>inductions; add that to 25% baseline average c/sxn rate from the
>remainder of the deliveries he did not induce (25% of 34= ~8) therefore
>he may have a rough c/sxn rate of about 32 (rought estimate), this is
>higher than the baseline ob 25% c/sxn rate which if one did 100
>deliveries they would have 25. What is your colleagues overall c/sxn
>rate compared to the group? compare that against the morbidities he
>encounters because of the extra c/sxn, and of course infections of both
>the neonate and mother, and finally do the neonatal outcomes differ in
>terms of morbidity (days in the NICU) and mortality. Bottom line is
>usually to compare neonatal morbidity and of course financial cost.
>At Wed, 30 May 2001, Steve & Eryl Raymond wrote:
>>
>>Of course it should be looked into. There is usually a reason why
>>patterns of practice evolve, usually they are based on medical evidence
>>about what procedures have the lowest risk. If somebody falls outside
>>of the range of usual practice of his peers, then either he has found
>>out something the others haven't; his practice population (case-mix) is
>>significantly different from the others; or he is practising high risk
>>procedures which other doctors would avoid.
>>
>>In order to avoid picking on an individual and thus risking shouts of
>>persecution, look at all inductions prospectively for a period of time
>>and make some comparisons and assessments on how many are medical and
>>how many are not.
>>
>>stray
>>
>>mark decker wrote:
>>
>>> pretty much exactly the question - just not directed at this one doc
>>> - as it seems people think the focus is on the one doc - it is not my
>>> main question at all..
>>>
>>> while he has the 66% induction rate - that IS NOT the issue -
>>> the issue - or more accurately the question is..
>>>
>>> does this rate <one individual or many> lead to higher morbidity -
>>> complications etc for mom and baby?
>>>
>>> if not - not so bad..
>>> but still - if it does not reduce risk either -...???
>>>
>>> does the list really feel it is perfectly ok to induce at say 66 or
>>> 75% or 100% if there is no benefit?
>>>
>>> is it really ok to have a rate of induction >50% if it does not lead
>>> to reduced risks and better outcomes?
>>>
>>> cost of induction over spontaneous labor?
>>> risk of suit if a maloccurence presents itself?
>>
>>Dr.S.H. Raymond
>>Head of Department of O & G
>>Empangeni Hospital
>>South Africa 3880
>>Phone: (+27) 35-7721111
>>Fax: (+27) 35-7922596
>
>--
>Vik MD, NY
>
--
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