Reducing Unnecessary Primary Cesarean Sections: A Quality Improvement Project

<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>

Name thesis:degree_name

Doctor of Nursing Practice (DNP)

Level thesis:degree_level

Open Access Thesis

Discipline thesis:degree_discipline

Yale University School of Nursing

Year

2022

Author dc:creator

• Suess, Jennifer L

Contributors dc:contributor

• Michelle Telfer

• cesarean section, interprofessional team, NTSV, nursing, pre-cesarean checklist, RN rate

Repository record dc:identifier

https://elischolar.library.yale.edu/ysndt/1142

OAI identifier oai:identifier

oai:elischolar.library.yale.edu:ysndt-1141