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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 2

(448) Safe reduction of NTSV Cesarean Delivery rates using multidisciplinary quality improvement efforts

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective: The rate of cesarean deliveries (CD) in nulliparous, term, singleton, vertex (NTSV) patients at our hospital has been ~30% since we began tracking this measure in 2016. Our aim was to evaluate the impact of quality improvement (QI) initiatives on this metric.

Study Design: Our level IV urban academic center formed a multidisciplinary workgroup in 4/2023. We reviewed CD rates stratified by indication, physician practice, race and ethnicity, which were regularly presented to the department and practice leaders. Nurses audited oxytocin management for adherence to hospital protocol and introduced non-pharmacologic options to help patients cope with labor pain. Retrospective chart review of all NTSV CD from 5-10/2023 determined if the indication for CD met ACOG criteria for failed induction of labor (FIOL), active phase arrest (APA), second stage arrest (SSA), and prelabor CD. Results were presented at departmental meetings and each physician was sent a scorecard with their total NTSV CD and adherence to ACOG criteria.

Results: The NTSV CD rate decreased in concordance with hospital QI efforts, to a nadir of 27.2% in the 2024 calendar year to date (Fig 1). Severe newborn complications (SNC) rate was similar before and after QI efforts (0.44% vs 0.61%, p</span>=0.13). Among all 298 NTSV CD, 13.8% did not meet ACOG criteria. FIOL was the most common indication (23%) that did not meet criteria across all racial and ethnic groups. Prelabor CD not meeting ACOG criteria were highest for White and Hispanic patients, driven by CD for estimated fetal weight lower than ACOG thresholds.

Conclusion:

Our hospital NTSV CD rate decreased without an increase in SNC rates. Our chart audit allowed us to identify an opportunity to target FIOL and prelabor CD as future interventions. Sharing disaggregated data coupled with detailed chart review to identify hospital-specific drivers of non-medically indicated CD may be strategies to safely reduce NTSV CD rate and drive quality improvement initiatives.