After several site visits to hospitals that initially were not participating in this initiative, six hospitals have expressed interest in joining Phase II of this initiative with two additional hospitals meeting with key stakeholders over the next few weeks to determine involvement.
The demographic survey has been completed by 20 of the 23 hospitals involved in this initiative and final results will be presented to teams in February.
As with the normal influx of patients desiring to deliver before the end of the year, teams across North Carolina have seen an upward trend in the cesarean rate with December’s data. We will continue our work towards decreasing the cesarean rate in Phase II of this initiative.
Updates
January 21, 2012
January 21, 2012
In December, teams across North Carolina had a slight upward trend of an increased cesarean rate among patients without risk factors. However, the overall cesarean rate for participating teams continues to decline with a continued statistically significant downward trend in the cesarean rate for patients with one or more risk factors for a cesarean (i.e. diabetes, IUGR, advanced maternal age, hypertensive disease, macrosomia, and obesity).
This month, hospitals were asked to complete a demographic survey answering questions determined by teams at the November Learning Session in Raleigh. Survey questions consisted of: the number of annual deliveries, the epidural rate, whether or not there is in-house anesthesia or in-house OB/GYN physicians or midwives on staff, whether or not there is 1:1 nursing care with patients on Oxytocin, and if there is a policy for not electively delivering before 39 weeks, 40 weeks or 41 weeks gestation. Half of the hospitals have completed the survey and full results will be presented upon completion of the survey by all hospitals. To date, hospitals that have completed the survey have shown a statistically significant difference in lower cesarean rates when midwives are on staff and ~54% (that have completed the survey) have a policy in place for not allowing elective deliveries < 39 weeks while ~15% have a policy for not allowing elective deliveries < 41 weeks gestation. Another question on the survey regarding hospitals with a policy for elective deliveries is showing a direct correlation between lower cesarean rates with greater weeks gestation (i.e. 39 weeks to 41 weeks gestation).
November 13, 2011
November 8, 2011
This month North Carolina hospital teams were brought together in one room to determine the next steps for decreasing our cesarean rate. Teams functioned as the state’s expert panel by using their knowledge and experiences to pinpoint specific areas for both process and practice improvements.
We continue to see a decline in the cesarean rate among patients with risk factors for cesarean section deliveries. Therefore, our expert panel is looking at what we can do to decrease the cesarean rate among the group of patients without risk factors for cesarean sections. We are also looking at patients that are not in labor and/or are not dilated upon presentation to our hospitals, as this group has shown to have over a two-fold increase for a cesarean over patients that present in labor and/or with a dilated cervix.
November 8, 2011
As teams across North Carolina continue to work collaboratively, we are slowly, yet steadily decreasing our cesarean rate. We continue to see a statistically significant decrease in the cesarean rate in North Carolina especially among patients with one or more risk factors for a cesarean (i.e. obesity, maternal age > 35 years, diabetes, hypertensive disease, intrauterine growth restriction).
October has been a month of planning and preparing for the November 2nd all day learning session in Raleigh. Teams are preparing for Phase II of the SIVB initiative which will include taking what we’ve learned in Phase I and honing in on specific areas to not only decrease our cesarean rate in the state, yet also to determine best practices based off our results in Phase I.
October 4, 2011
As we continue to move towards lowering our cesarean section rate among our targeted patient population (nulliparous women at term with a singleton, vertex fetus, without contraindications to vaginal delivery and not admitted for scheduled cesarean), we have seen a 14.69% decrease in cesareans! This work truly represents a collaboration of hospitals as it is not the result of a few hospitals showing large changes, but a gradual decrease among multiple hospitals.
Our largest downward trend is the cesarean section rate of patients with one or more risk factors such as diabetes, obesity, advanced maternal age, or hypertensive disease (38.17% to 27.97%). We are also seeing that patients not in labor on admission have a 32.19% cesarean rate as compared to patients IN LABOR on admission (14.52% cesarean rate), meaning patients NOT IN LABOR on admission have over twice the likelihood of having a cesarean section.
There has been a slightly downward trend in documented labor support methods of assistance and support from families/friends. There has also been a decline in the 1:1 nursing care which may be related to this typically being the time of year with the highest volume of patients on most labor & delivery units.
September 18, 2011
Where: McKimmon Center, 1101 Gorman St, Raleigh, NC 27606
When: Wednesday, November 2, 2011 9:00 - 3:30
What: Up to five team members - all three primary team members (physician champion, nurse champion, senior hospital administrator) are encouraged to attend. Lunch and materials will be provided at no cost.
How: Pre-register here
August 8, 2011
We are learning, improving, and really seeing the importance of working together as a collaborative - some results to date include:
- a decrease (38% to 30%) among patients with >/= to one or more risk factors of C-section delivery.
- of the patients admitted in labor, the c-section rate is 14.9%.
- of the patients admitted not in labor, the c-section rate is 32.6%.
- the more dilated a patient is on admission, the less likely she is to have a c-section.
- there’s an increase (60.74% to 65.87%) in the use of IUPCs in place when c-section for FTP is called.
- an increasing trend in the use of labor support.
July 12, 2011
With six months of data now available (two baseline months in October and November 2010, and four months of data collection during the active phase of the initiative, February – May 2011), the effects of all the work being done at SIVB hospitals is beginning to be seen. The c-section rate among the target population (nulliparous women at term with a singleton, vertex fetus, without contraindications to vaginal delivery, not admitted for scheduled c-section) across all participating hospitals was 22.19% in May 2011, compared to 24.77% at baseline, representing a 10% decrease. We are hopeful that this trend will continue in future months!
The July webinar focused on the challenges SIVB teams have expressed in terms of engaging physicians in some of the strategies hospitals are considering in order to promote vaginal birth, such as limiting or eliminating elective induction of labor. These strategies appear to be more widely accepted when they address common interests, such as minimizing congestion in the L&D unit, allowing more scheduling flexibility for medically indicted inductions of labor. Given the shared interests of those physician practices participating in the CCNC Pregnancy Medical Home program for Medicaid patients, which focuses on the primary c-section rate, and the SIVB hospitals, teams may want to consider partnering locally with the OB physician champion and OB nurse coordinator from the CCNC network.