Background: The cesarean section (CS) is the most common surgical procedure in the United States and while often necessary and life-saving, brings higher risk of morbidity and mortality for both patient and neonate than vaginal birth (Boyle et al., 2013; Lagrew et al., 2018). CS rates in nulliparous, term, singleton, vertex (NTSV) patients vary dramatically, from 7.1% to 69.9%, throughout US birthing facilities but can be safely reduced via the implementation of evidence-based safety bundles that aim to reduce variation in care (Council on Patient Safety in Women’s Health Care, 2020; Kozhimannil et al., 2013). Local Problem: A large birthing hospital in Maryland has NTSV CS rate of 23% with a reduction goal to 20% or less. Methods: Plan-Do-Study-Act Cycles were utilized as the project model over 3-month period. Intervention: CS rate reporting was scaled out to include Registered Nurse (RN)-specific rate measures in the established clinician audit and feedback process while also tailoring and launching a CS communication tool. Results: While unit CS rates did not decrease during the project period, the RN-specific CS rate measures did identify positive outlier RNs with NTSV CS rates consistently lower than goal, ranging for 0.00% to 16.67%. Conclusion: This project demonstrates the need for continued analysis of RN-specific NTSV CS rates to identify and study the practices of these positive outliers to identify best practices, direct from the frontline, that contribute to successful, safe physiologic birth. Keywords: NTSV, cesarean section, quality improvement, RN NTSV rate, interprofessional team, pre-cesarean checklist
","abstract_html":"<p>Background: The cesarean section (CS) is the most common surgical procedure in the United States and while often necessary and life-saving, brings higher risk of morbidity and mortality for both patient and neonate than vaginal birth (Boyle et al., 2013; Lagrew et al., 2018). CS rates in nulliparous, term, singleton, vertex (NTSV) patients vary dramatically, from 7.1% to 69.9%, throughout US birthing facilities but can be safely reduced via the implementation of evidence-based safety bundles that aim to reduce variation in care (Council on Patient Safety in Women’s Health Care, 2020; Kozhimannil et al., 2013). Local Problem: A large birthing hospital in Maryland has NTSV CS rate of 23% with a reduction goal to 20% or less. Methods: Plan-Do-Study-Act Cycles were utilized as the project model over 3-month period. Intervention: CS rate reporting was scaled out to include Registered Nurse (RN)-specific rate measures in the established clinician audit and feedback process while also tailoring and launching a CS communication tool. Results: While unit CS rates did not decrease during the project period, the RN-specific CS rate measures did identify positive outlier RNs with NTSV CS rates consistently lower than goal, ranging for 0.00% to 16.67%. Conclusion: This project demonstrates the need for continued analysis of RN-specific NTSV CS rates to identify and study the practices of these positive outliers to identify best practices, direct from the frontline, that contribute to successful, safe physiologic birth. Keywords: NTSV, cesarean section, quality improvement, RN NTSV rate, interprofessional team, pre-cesarean checklist </p>","abstract_has_math":false,"creators":["Suess, Jennifer L"],"institution":null,"degree_name":"Doctor of Nursing Practice (DNP)","degree_level":"Open Access Thesis","degree_discipline":"Yale University School of Nursing","degree_department":null,"school":null,"contributors":["Michelle Telfer"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2022,"date_issued":"2022-01-01T08:00:00Z","date_published":"2022-01-01T08:00:00Z","updated_at":"2026-07-24T06:16:14Z","subjects":["cesarean section, interprofessional team, NTSV, nursing, pre-cesarean checklist, RN rate"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://elischolar.library.yale.edu/ysndt/1142","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Michelle Telfer"]},{"key":"dc:creator","label":"Author","values":["Suess, Jennifer L"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"thesis:degree_discipline","label":"Discipline","values":["Yale University School of Nursing"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Open Access Thesis"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Nursing Practice (DNP)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["cesarean section, interprofessional team, NTSV, nursing, pre-cesarean checklist, RN rate"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://elischolar.library.yale.edu/ysndt/1142"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background: The cesarean section (CS) is the most common surgical procedure in the United States and while often necessary and life-saving, brings higher risk of morbidity and mortality for both patient and neonate than vaginal birth (Boyle et al., 2013; Lagrew et al., 2018). CS rates in nulliparous, term, singleton, vertex (NTSV) patients vary dramatically, from 7.1% to 69.9%, throughout US birthing facilities but can be safely reduced via the implementation of evidence-based safety bundles that aim to reduce variation in care (Council on Patient Safety in Women’s Health Care, 2020; Kozhimannil et al., 2013). Local Problem: A large birthing hospital in Maryland has NTSV CS rate of 23% with a reduction goal to 20% or less. Methods: Plan-Do-Study-Act Cycles were utilized as the project model over 3-month period. Intervention: CS rate reporting was scaled out to include Registered Nurse (RN)-specific rate measures in the established clinician audit and feedback process while also tailoring and launching a CS communication tool. Results: While unit CS rates did not decrease during the project period, the RN-specific CS rate measures did identify positive outlier RNs with NTSV CS rates consistently lower than goal, ranging for 0.00% to 16.67%. Conclusion: This project demonstrates the need for continued analysis of RN-specific NTSV CS rates to identify and study the practices of these positive outliers to identify best practices, direct from the frontline, that contribute to successful, safe physiologic birth. Keywords: NTSV, cesarean section, quality improvement, RN NTSV rate, interprofessional team, pre-cesarean checklist
"]},{"key":"dc:title","label":"Title","values":["Reducing Unnecessary Primary Cesarean Sections: A Quality Improvement Project"]}]}],"canonical_facts":{"dc:contributor":["Michelle Telfer"],"dc:creator":["Suess, Jennifer L"],"dc:description.abstract":["Background: The cesarean section (CS) is the most common surgical procedure in the United States and while often necessary and life-saving, brings higher risk of morbidity and mortality for both patient and neonate than vaginal birth (Boyle et al., 2013; Lagrew et al., 2018). CS rates in nulliparous, term, singleton, vertex (NTSV) patients vary dramatically, from 7.1% to 69.9%, throughout US birthing facilities but can be safely reduced via the implementation of evidence-based safety bundles that aim to reduce variation in care (Council on Patient Safety in Women’s Health Care, 2020; Kozhimannil et al., 2013). Local Problem: A large birthing hospital in Maryland has NTSV CS rate of 23% with a reduction goal to 20% or less. Methods: Plan-Do-Study-Act Cycles were utilized as the project model over 3-month period. Intervention: CS rate reporting was scaled out to include Registered Nurse (RN)-specific rate measures in the established clinician audit and feedback process while also tailoring and launching a CS communication tool. Results: While unit CS rates did not decrease during the project period, the RN-specific CS rate measures did identify positive outlier RNs with NTSV CS rates consistently lower than goal, ranging for 0.00% to 16.67%. Conclusion: This project demonstrates the need for continued analysis of RN-specific NTSV CS rates to identify and study the practices of these positive outliers to identify best practices, direct from the frontline, that contribute to successful, safe physiologic birth. Keywords: NTSV, cesarean section, quality improvement, RN NTSV rate, interprofessional team, pre-cesarean checklist
"],"dc:identifier":["https://elischolar.library.yale.edu/ysndt/1142"],"dc:subject":["cesarean section, interprofessional team, NTSV, nursing, pre-cesarean checklist, RN rate"],"dc:title":["Reducing Unnecessary Primary Cesarean Sections: A Quality Improvement Project"],"thesis:degree_discipline":["Yale University School of Nursing"],"thesis:degree_level":["Open Access Thesis"],"thesis:degree_name":["Doctor of Nursing Practice (DNP)"]},"updated_at":"2026-07-24T06:16:14Z"}