Author(s): Deborah Miller, MPH, BSN, RN, CPHQ
Program Manager, Quality
Northwestern Memorial Hospital

Competency Domain: Performance & Process Improvement

Description: Northwestern Memorial Hospital, a Level III Perinatal Center located in Chicago, Illinois was a participant in the Illinois Perinatal Quality Collaborative's Promoting Vaginal Birth Initiative. A multidisciplinary team comprised of physicians, nurse midwives, nurses and quality professional developed educational materials and communication tools along with a process for data transparency. This session will describe our journey to decrease the NTSV Cesarean Section rate (nulliparous, term, singleton, vertex presentation) and maintain it below the 2030 Healthy People goal of 23.6%. Problem:With rising cesarean section rates, data review identified that the clinical indication for cesarean when documented, did not always align with ACOG recommendations.Measurement:A sample of cesarean section cases were reviewed monthly for compliance with ACOG cesarean indication recommendations. Run charts displayed the monthly compliance rates as well as the monthly and quarterly NTSV cesarean section rates. Analysis:Overall NTSV cesarean section rates and ACOG indication compliance were reviewed. Quarterly practice rates were generated with individual physician rates included within the practice report. In addition to the collaborative project, data was reviewed for other variables such as race, ethnicity, insurance status, language, age, and BMI. Implementation:Project overview and education on the ACOG/SMFM guidelines for cesarean section was provided to the Department. Interventions include a template for cesarean section indication documentation; distribution of quarterly practice reports; creation of a patient labor induction brochure and development of a staff guide to labor support. Results/DiscussionThe NTSV Cesarean Section Rate has decreased over the past four calendar years. Compliance with ACOG/SMFM guidelines has been consistent. Data transparency through information sharing at Quality Committee and Department meetings as well as the Practice/Individual provider feedback was instrumental in sustaining our results.