Michelle Telfer
Yale University
Michelle is a graduate of the University of California at Berkeley, Tulane University School of Public Health where she received an MPH, and Columbia University where she received her master’s in midwifery. She received her Doctorate of Nursing Practice from Frontier Nursing University. She is faculty at Yale University.
Abstract
Background: Reducing cesareans is a priority for healthcare and professional organizations. Labor dystocia is the leading cause of cesareans. Delaying hospital admission until active labor is established is one evidenced-based method to decrease labor dystocia diagnoses. Evidence is lacking on how to best accomplish this, but several interventions have been studied including admission algorithms and patient and staff education. The aim of this project was to reduce early labor admissions and support physiologic birth through implementing evidenced based tools and thereby decrease the nulliparous term singleton vertex cesarean rate. The birthing center had no written guideline for early labor admission or tools to provide patients and staff in supporting delayed labor admission until active labor. The birthing center had 1,000 births and a 22% cesarean rate in 2015 and it was believed this rate could be safely decreased. Participants included nurse-midwives, obstetricians, residents, nurses, and nurse-midwifery students.
Methods: Chart reviews and a literature review were conducted to identify gaps in practice. Baseline data were gathered on staff readiness, knowledge, and attitudes as well as baseline statistics. Evidence-based bundles of tools including a triage algorithm, early labor walking path, and patient and staff education were introduced. A patient experience survey was developed and administered throughout the project. Four “Plan-Do-Study-Act” cycles were conducted over eight weeks with four ramps each cycle: staff education, a new process component, patient experience and a data driven change. Run charts were used to track changes and variations and to determine if interventions were causing the change.
Results: The triage algorithm reduced early labor admission from 41% to 25% and physiologic birth increased by 2% after the intervention. Patient experience satisfaction rates were highly positive exceeding 98%. The NTSV cesarean rate reduced slightly from 22% in 2015 to 21% during this project.
Conclusions: Implementing evidenced-based guidelines are effective at reducing early labor admissions and supporting physiologic birth while maintaining high patient satisfaction and improved staff knowledge and engagement. Over time, these efforts have the potential to reduce cesarean birth rates and the associated maternal and neonatal morbidities.
Ethical concerns statement: Approval for the project was obtained from the Health Research and Clinical Data Department which designated the quality improvement project exempt from the IRB process. There was no cost to the unit or patients.
Funding: No funding was provided for this project, however, as part of the American College of Nurse-Midwives Reducing Primary Cesarean Collaborative, technical support through monthly webinars and pre and post-implementation meetings were funded through the Transforming Birth Fund.
Results will be presented at the conference through an oral presentation and/or a poster presentation.
1. Studies that integrate knowledge from a range of scientific approaches and/or perspecti , Studies of and contributions to practice and/or service organisation , Studies of collaboration to improve maternal, infant, family, and maternity staff wellbein
