Impact of clinical audits on cesarean section rate

Peng, Fu-Shiang; Lin, Ho-Hsiung; Lin, Ho‐Hsiung; Tu, Fung-Chao; Hsiao, Chin-Fen; Hsiao, Sheng‐Mou

doi:10.1016/j.tjog.2014.12.015

Cited by 11 publications

(10 citation statements)

References 19 publications

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“…They identified high rates of unnecessary and potentially preventable cesarean sections. Another study also showed that a clinical audit is an effective strategy for reducing the cesarean section rate and recommended strict monitoring of the indications for cesarean sections to reduce the cesarean section rate [28]. Therefore, future research needs to consider conducting an audit of the indications for cesarean sections rather than measuring the cesarean section rate alone.…”

Section: Discussionmentioning

confidence: 99%

Rates and trends in cesarean sections between 2008 and 2012 in Iraq

Shabila

2017

BMC Pregnancy Childbirth

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BackgroundThe prevalence of cesarean sections is increasing globally; however, it can lead to significant increases in maternal and infant morbidity and mortality. This study aimed to determine the rates and trends of cesarean sections in Iraq.MethodsThe cesarean section rates of all births and public and private hospital-based births were calculated from the data on births provided by the annual reports of the Iraqi Ministry of Health for the years 2008 and 2012. The comparable rates for the Center/South and Kurdistan Region and the individual governorates were determined. The cesarean section rates for all births in 2008 were computed and compared with the 2012 rates.ResultsThe cesarean section rate for all births in Iraq was 24.4% in 2012, which was similar to the rates in the Iraqi Kurdistan Region (25.4%) and the Center/South of Iraq (24.3%). The cesarean section rates were specifically high in the governorates containing a larger number of private hospitals, and there was a significant positive relationship between the number of private hospitals and the cesarean section rate (beta = 0.671; r = 0.671; P < 0.002). The hospital-based cesarean section rate was 34.7%. The cesarean section rate in private hospitals (77.9%) was remarkably higher than the rate in public hospitals (29.3%). The overall rate of cesarean sections in Iraq increased from 18.0% in 2008 to 24.4% in 2012.ConclusionsThe cesarean section rate in Iraq is far above the recommended rate. Iraq witnessed a rapid upward trend in the cesarean section rate from 2008 to 2012, with most of this trend attributable to the Kurdistan Region. There is a potential relationship between the expansion of the private health sector and the increasing cesarean section rate, and further studies of this relationship are necessary. Future research should consider an audit of the indications for a cesarean section rather than measuring the cesarean section rate alone.

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Section: Discussionmentioning

confidence: 99%

Rates and trends in cesarean sections between 2008 and 2012 in Iraq

Shabila

2017

BMC Pregnancy Childbirth

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“…Best practice rates that have been published for Robson‐1 women are as low as 3% or 6.6%, although most published rates are higher: 12.6 to 23.1%. Other centres have demonstrated that a combination of clear targets, training, and continuous feedback can result in reductions in caesarean section rates without an adverse effect on neonatal outcomes . We have introduced a caesarean section audit in which decision making is analysed retrospectively.…”

Section: Discussionmentioning

confidence: 99%

“…We also identified one paper on benchmarking outcomes for women with hypertensive disorders of pregnancy, which has a similar aim for a different population. There are multiple papers reporting on single goal improvement initiatives regarding both reducing caesarean section rates and reducing OASIS, but these studies look at one specific outcome instead of considering a wider set of outcomes for a particular group of women. We used the ICHOM‐standardized outcome set as an ideal and demonstrated that even without access to all these outcomes, it is possible to identify potential improvements.…”

Section: Discussionmentioning

confidence: 99%

Value‐based health care in obstetrics

Berg

Dijksman

Keus

et al. 2019

Evaluation Clinical Practice

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Rationale, Aims, and Objectives:We strive to maximize outcomes that are relevant to the women who deliver in our hospital. We demonstrate a practical method of using value-based health care (VBHC) concepts to analyse how care can be improved. Method: Using International Consortium of Health Outcome Measurements(ICHOM) set, a practical outcome set was constructed for women who go into spontaneous labour at term of a singleton in cephalic presentation and used for benchmarking. We included data on interventions that are major drivers of outcomes.Data from two hospitals in Amsterdam and for The Netherlands for 2011 to 2015 were collected. Results:Benchmarking of readily available data helped identify a number of statistically significant and clinically relevant differences in obstetric outcomes. Caesarean section rate was significantly different at 13.7% in hospital 2 compared with 11.5% in hospital 1 with similar neonatal outcomes. Third and fourth degree tearing rates were significantly higher for hospital 1 at 5.5% compared with 3.6% for hospital 2 and the national average of 3.5%. On the basis of the guidelines, literature, and discussion, initiatives on how to improve these outcomes were then identified. These include caesarean section audit and guidelines regarding caesarean section decision making. In order to reduce the rate of third and fourth degree tearing, routine episiotomy on vaginal operative deliveries was introduced, and a training programme was set up to make care providers more aware of risk factors and potential preventive measures. Conclusion:Defining, measuring, and comparing relevant outcomes enable care providers to identify improvements. Collection and comparison of readily available data can provide insights in where care can be improved. Insights from literature and comparison of care practices and processes can lead to how care can be improved. Continuous monitoring of outcomes and expanding the set of outcomes that is readily available are key in the process towards value-based care provision. KEYWORDScaesarean section, outcomes, quality improvement, Robson-1, value-based health care, VBHC *Apgar score is a measure to summarize the health of newborn children, evaluating newborns on skin color, pulse rate, reflex, activity, and respiratory effort. † Third and fourth degree perineal ruptures involve tearing of the anal sphincter and anal mucosa. ‡ Defined as more than 1000 mL of blood loss.

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“…Significant between‐hospital variation in CD rates has been documented 6,7 . Audit and feedback of delivery mode rates has become a widely used method of initiating practice changes to improve care by safely reducing CD rates 8‐10 . To date, this strategy has been used exclusively with physicians despite the crucial role of nurses in intrapartum labor management, 11 known variation in nurse‐level CD rates, 12,13 and the American Congress of Obstetricians and Gynecologists recommendation that hospitals review individual CD rates for nurses 14 .…”

Section: Introductionmentioning

confidence: 99%

Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points

Edmonds

Weiseth

Neal

et al. 2020

Health Services Research

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Objective To examine the variability in the cesarean delivery (CD) rates of individual labor and delivery nurses compared with physicians at three attribution time points. Data Sources Medical record data from nine hospitals in Washington State from January 2016 through September 2018. Study Design Retrospective, observational cohort design using an aggregated database of birth records. Data Collection/Extraction Methods Chart‐abstracted clinical data from a subset of nulliparous, term, singleton, vertex births attributed at admission, labor management, and delivery to nurses and physicians. Two classification methods were used to categorize nurse‐ and physician‐level CD rates at three attribution time points and the reliability of these methods compared. Principal Findings The sample included 12 556 births, 319 nurses, and 126 physicians. Overall, variation in nurse‐level CD rates did not differ significantly across the three attribution time points, and the extent of variation was similar to that observed in physicians. However, agreement between attribution time points varied between 35 percent and 65 percent when classifying individual nurses into the top and bottom deciles. The average reliability of nurse‐level CD rates was 32 percent at admission (IQR 22.0 percent to 38.7 percent), 32.6 percent at labor (IQR 23.1 percent to 40.9 percent), and 29.3 percent (IQR 20.9 percent to 35.8 percent) at delivery. The average reliability of physician‐level CD rates was higher: 54.2 percent (IQR 38.7 percent to 71.4 percent) at admission, 62.5 percent (IQR 49.0 percent to 79.6 percent) at labor management, and 66.1 percent (IQR 53.7 percent to 81.2 percent) at delivery. Conclusion Feedback on nurse‐level CD rates as part of routine clinical quality audits can provide insight into nurse performance in the context of other individual‐level and unit‐level information. To reliably distinguish individual nurse performance, larger sample sizes are needed.

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Impact of clinical audits on cesarean section rate

Abstract: Clinical audits appear to be an effective strategy for reducing the CSR. Therefore, we recommend strict monitoring of the indications in dystocia for cesarean section to reduce the CSR.

Cited by 11 publications

References 19 publications

Rates and trends in cesarean sections between 2008 and 2012 in Iraq

Rates and trends in cesarean sections between 2008 and 2012 in Iraq

Value‐based health care in obstetrics

Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points

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