Re: 66% Induction Rate
From: Efrain Ramirez (eramirez@icepr.com)
Wed May 30 08:14:50 2001
ooops -- that should be,of course, 30 not 0- sorry --
At Wed, 30 May 2001, Efrain Ramirez wrote:
>
>"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
>>
>--
>"Life is neither the notes nor the silence between the notes, but the music that
> arises out of sound and silence felt as a living whole. Stop choosing...between
> chaos and order, and live at the boundary between them, where rest and action
> move together..." David Whyte
>
--
"Life is neither the notes nor the silence between the notes, but the music that
arises out of sound and silence felt as a living whole. Stop choosing...between
chaos and order, and live at the boundary between them, where rest and action
move together..." David Whyte
