Quality improvement initiative lowers C-section rates by more than 10 percent at Deaconess Medical Center

A long-term, multi-strategy quality improvement initiative resulted in a significant reduction in the number of births by cesarean section at Beth Israel Deaconess Medical Center in Boston, according to a new study published in The Joint Commission Journal on Patient safety.

For the study, researchers established factors that may increase the likelihood of a cesarean delivery in nulliparous term singleton vertex cesarean pregnancies. These are women who deliver a baby with its head positioned down at 37 weeks or more, traits that should reduce the likelihood of cesarean delivery. Established factors included the interpretation and management of fetal heart rate, the hospital's childbirth capacity and provider awareness, among others.

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From 2008 through 2015, the researchers applied a multi-strategy approach, including provider education and provider feedback, to address the factors contributing to high C-section rates. The strategic initiative included patient education and provider feedback. During this time period, C-section rates among this patient population dropped from 34.8 to 21.2 percent and the total cesarean delivery rate decreased from 40 to 29.1 percent.

"Nearly one third of births in the United States occur with cesarean delivery. Compared to vaginal delivery, cesarean delivery is associated with increased morbidity and mortality," wrote the study's authors. "A reduction in NTSV cesarean delivery rate may have a substantial impact on healthcare. Hospitals can implement quality improvement initiatives reported here to decrease NTSV cesarean delivery rate. Aspects of this project such as provider education, provider feedback and change in policy are generalizable to many institutions."

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