After a very successful kickoff meeting for the PQCNC AIM Reducing Primary Cesarean Section initiative, it is now time for teams to begin planning, setting goals and implementing interventions. A facility intervention tracker was reviewed at the kickoff meeting and teams were given time to determine what elements of the action plan they currently have in place, prioritize outstanding interventions and set a goal timeline for implementation. The facility intervention tracker and planning forms can be found here. Based on a review of the baseline snapshot information submitted, participating teams had an NTSV cesarean section rate of 26% for June 2018, 27% for July 2018 and 27% for August 2018. With goals of 23.9% for each facility and a statewide stretch goal of 20%, it’s time to get to work!
Updates
The kickoff meeting for the upcoming AIM Reducing Primary Cesarean Section initiative is scheduled for January 24, 2019. If you haven’t registered your team for the initiative yet, please consider joining us as we work to improve maternal outcomes by safely decreasing the number of nulliparous, term, singleton, vertex (NTSV) cesarean section deliveries performed in North Carolina. Facilities of all sizes that have been able to sustain a low NTSV cesarean delivery rate will be sharing processes and workflows that have enabled their success. Teams will be able to prioritize a number of interventions to implement as they work towards the statewide goal of a 20% NTSV cesarean section delivery rate. Come join us in making deliveries safer for the women and infants across North Carolina.
If you’d like to join us in our work, please register your team here.
If you’d like to attend the kickoff meeting, please register here.
All teams participating in the PQCNC AIM Reducing Primary Cesarean Section (RPC) initiative will be completing a baseline questionnaire prior to the kickoff of the initiative to determine what processes are currently in place to support healthy birth and labor at each individual facility. These process and structure measures will serve as a starting point for teams to begin planning improvement cycles and set facility goals during the initiative.
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.
