The North Carolina Department of Vital Statistics tracks the number of primary and total cesarean section deliveries by delivery center and county each year. As teams are gearing up for participation in the AIM Reducing Primary Cesarean Section initiative, state statistics are being shared with all facilities to gain a better understanding of their data. Gathering a baseline of data will enable teams to determine where to concentrate efforts as individual facility action plans are created.
As individual facility teams across North Carolina prepare to participate in the PQCNC AIM Safe Reduction of Primary Cesarean Section (AIM RPC) initiative, there are several documents to review that will enhance understanding of and facilitate improvement teamwork. All initiative documents are posted on the PQCNC website.
The AIM RPC charter and action plan outline the goals of the initiative and the interventions teams are encouraged to incorporate to meet those goals. Additionally, initiative pre-work providing step by step instructions on how to get registered, what resources are available and what access will be necessary to enter data is included. Data collection sheets and data dictionaries are available so teams can investigate how to obtain the necessary data to report.
The charter, action plan and data collection documents have been finalized with guidance from the members of the Expert Team. We are ready to begin recruiting for the AIM Reduction of Primary Cesarean Section (RPC) initiative!
The graph below shows provisional data from 2017 for the primary CS rate for all delivery hospitals in North Carolina. The expert team decided upon an individual facility goal of 23.9% (top black line) in accordance with Healthy People 2020 and a statewide goal of 20% (lower black line). Primary CS rates in North Carolina range from approximately 11% to around 38%. With such variation, we all have much to learn from each other to collectively reach the statewide goal of 20%.
The initiative documents can be found here. The PQCNC team will be working with and supporting all AIM RPC teams to reach the goals set by the Expert Team.
The AIM RPC expert team has worked diligently to provide insight and guidance regarding the formation of the initiative documents. Final drafts of the charter, action plan and data collection forms are currently out for comment. The agreed upon outcomes for the initiative include:
▪ defining the needed infrastructure to reduce primary cesarean section delivery at each obstetrical unit
▪ demonstrating 100% compliance with all the AIM RPC structure metrics
▪ ensuring that all women having an NTSV Cesarean section have met the ACOG/SMFM Cesarean Criteria
▪ having a statewide average NTSV Cesarean rate at or below 20.0% and a hospital NTSV Cesarean rate at or below the Healthy People goal of 23.9%
▪ Demonstrating no change in newborn outcome by route of delivery measured by 5-minute Apgar scores of < 7 and admission to the NICU stratified by reason for admission
In the second in a series of calls, the AIM RPC expert team has moved closer to finalizing the charter and defining the goals of the initiative. Consensus was reached in defining a balancing measure of no change to newborn outcomes by route of delivery measured by a five minute Apgar score of less than seven and admission to the NICU stratified by reason for admission. Discussion will continue on the next call around an appropriate goal for a statewide NTSV CS rate, as well as, determining the feasibility of the proposed elements of the action plan.
The Expert Team is reviewing the draft charter and action plan for the RPC initiative. Team members are providing feedback on process and outcome measures as we move toward finalizing the charter on the upcoming expert team call in May. More discussion will be held on the upcoming call regarding elements of the action plan as team members decide on appropriate interventions to reach the goals outlined in the charter.
The first conference call for the expert team of the Reducing Primary Cesarean Section (RPC) initiative is scheduled for the beginning of April. Representatives from facilities across North Carolina have registered as experts and are preparing to share their knowledge and insights in the creation of the initiative charter and action plan. All participating teams will be examining their primary and total CS rates and determining what other outcomes they would like to impact during the initiative.
According to the North Carolina Department of Health and Human Services, the total cesarean section (CS) rate in NC in 2016 is 29.4%. In national state rankings from highest CS rate to lowest CS rate, NC comes in at 33rd. Throughout the state, there are counties and hospitals with exceptionally low total CS rates, such as Wake Med Raleigh campus, who were highlighted by Consumer Reports in 2014 for a total CS rate of just 11.6%.
As the initiative to reduce primary CS develops, teams will be focusing on decreasing primary, low risk CS deliveries but will be following total CS rates as well. Teams who have been able to decrease their CS rates and sustain their progress will be collaborating with other teams and leading the charge towards improving maternal care in North Carolina.
PQCNC is proud to announce that registration is now open for the statewide Safe Reduction of Primary Cesarean Birth (RPC) initiative.
The RPC Expert Team will create a concise action plan which will guide hospital RPC teams in this work as well as measures which will guide teams and the collaborative in this work.
The RPC collaborative will be facilitated by the PQCNC core team working with your hospital teams and, as with all PQCNC initiatives, will include informative webinars and quarterly face to face learning sessions as well as weekly email updates to keep all apprised of new reports on the topic, opportunities to excel developed by teams, and critical developments in the collaborative.
The PQCNC RPC initiative offers your facility a unique, structured opportunity to address the challenges of safe reduction of primary cesarean birth. Our face to face learning sessions will offer CEU and CME credit.
This all is at NO cost to your hospital.
Want to join us on this incredible journey? - use the links at right