Premium
Promoting effective care: Reducing primary cesarean births through team engagement and standardization of care at a community hospital
Author(s) -
Wise Gay,
Jolles Diana
Publication year - 2019
Publication title -
nursing forum
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.618
H-Index - 36
eISSN - 1744-6198
pISSN - 0029-6473
DOI - 10.1111/nuf.12384
Subject(s) - checklist , medicine , audit , perinatal mortality , community hospital , population , nursing , emergency medicine , family medicine , obstetrics , pregnancy , psychology , fetus , management , environmental health , biology , economics , cognitive psychology , genetics
Background The overuse of cesarean births (CBs) in the United States has led to increased rates of maternal and infant morbidity and mortality. Local Problem The nulliparous, term, singleton, vertex (NTSV) CB rate at this community hospital was 32.3% in 2017, well above the Healthy People 2020 target of 23.9%. The aim of this project was to decrease the NTSV CB rate by five percentage points in a 7‐week period. Methods Four plan‐do‐study‐act cycles focused on team engagement and process changes. Team huddles utilizing the best practices checklist to standardize care for labor dystocia and abnormal fetal tracings, as well as audits of unplanned CB, were implemented. SQUIRE guidelines were used in the preparation of this manuscript. Results Over 7 weeks, 13 of 55 NTSV patients gave birth by cesarean, resulting in an NTSV CB rate of 23.6%. Fifty‐three huddles were held by 218 staff members for 28 patients. Team engagement scores improved from 85% to 98%. Although the effective care CB scores trended upward, the overall mean was 51%. Conclusions Interdisciplinary team huddles, coupled with the use of a best practices checklist and feedback from audits, achieved a more effective use of CB in the NTSV patient population.