Safely Reducing Cesareans Through Reducing Early Labor Admissions and Promoting Labor Progress

Introduction: National healthcare and professional organizations have made reducing nulliparous, term, singleton, vertex (NTSV) cesareans a priority. Implementation of evidence-based bundles have demonstrated effectiveness in... [ view full abstract ]

Introduction: National healthcare and professional organizations have made reducing nulliparous, term, singleton, vertex (NTSV) cesareans a priority. Implementation of evidence-based bundles have demonstrated effectiveness in safely reducing NTSV cesareans. The aim of this quality improvement project (QI) was to safely reduce the NTSV rate at St. Raphael’s Campus of Yale New Haven Health from 22% and to increase the physiologic birth rate through implementing an early labor triage algorithm, a labor coping checklist, a partograph, and a pre-cesarean checklist adapted from national toolkits and bundles.

Methods: Baseline data was gathered on staff readiness, knowledge, and attitudes toward elements of the project as well as baseline statistics of key measurements. Four Plan Do Study Act cycles were conducted over eight weeks. Education of multidisciplinary staff on the benefits and use of the tools was conducted. A patient experience survey was developed and administered throughout the project.

Results: The NTSV cesarean rate reduced from 22% in 2015 to 17% during the project period. The early labor triage guide succeeded in reducing early labor admissions from 41% the month prior to the project to 25% during the project. We increased physiologic birth by 2% during the intervention. Patient experience satisfaction rates were highly positive exceeding 95%.

Conclusions: Implementing evidenced-based bundles are effective at safely decreasing NTSV cesarean rates and supporting physiologic birth. Additionally, the introduction of the early labor triage algorithm, coping checklist, partograph, and pre-cesarean checklist helped to improve staff knowledge and engagement while maintaining high patient satisfaction rates.