Quality improvement initiative successfully and sustainably reduces the nulliparous, term, singleton, vertex cesarean rate

About the Program

Category: Health (Best in Category)

Year: 2023

The Nulliparous, Term, Singleton, Vertex (NTSV) committee was implemented to reduce the rate of unnecessary cesarean births in a low risk population. By reducing the number of unnecessary cesarean births in a person’s first pregnancy, it will reduce the number of necessary subsequent cesarean births, which have increased morbidity and mortality compared to vaginal births. While Olive View-UCLA had previously met the goals rate of 23.6% set by the CDC in Healthy People 2030, in 2020 and early 2021, the cesarean birth rate in this population had increased well above the goal rate. This committee developed and implemented a QI initiative using a “Plan-Do-Study-Act” (PDSA) methodology which included: summary and dissemination of “best practices” for the safe prevention of primary cesarean birth (cycle 1), monthly in-depth case review and direct, targeted feedback to care teams when best practice expectations were not met (cycles 2, 3), monthly educational sessions on management of category 2 fetal heart rate tracings (cycles 2,3), and a best practices “refresher” (cycle 3). Monthly NTSV cesarean birth rates (CBR) were tracked, reviewed, and reported prospectively using birth log data. Through this project, the average monthly NTSV cesarean birth rate (CBR) decreased to 27.5% during PDSA cycle 1, then 15.5% during cycle 2, and ultimately 5.2% during cycle 3 (currently ongoing).