Database prompts docs to cut C-section rates

Physicians affiliated with Grace Hospital in Morganton, NC, used data from the QI Project, sponsored by the Maryland Hospital Association in Lutherville to dramatically reduce cesarean rates.

The Quality Improvement Committee, made up of 12 physicians in various disciplines, targeted the cesarean rate in January 1995. At 35%, it was well above the mean of the QI Project database of 20.94%. By June 1997, the rate had dropped to 17%, which is the 25th percentile.

Report detailed rate by doctor

Having data helped spur changes in practice, says Susan Epley, RN, the hospital’s quality improvement coordinator. The QI Project provided customized reports comparing the hospital to those of a similar size and patient population in the Southeast. She also developed reports showing the cesarean rate of each obstetrician.

"When I got those individualized reports, it wasn’t hard at all to get physician buy-in [for improvements]," says Epley. "When they started talking about it and looking at their data, we started to see changes."

A quality team determined ways to reduce cesarean rates, including increased use of epidurals and other alternative forms of pain management, protocols for the induction and augmentation of labor, and improvements in patient education. Specifically, patients were given additional information about vaginal birth after cesareans.

All cesareans related to insufficient contractions were reviewed by physician peers. And the committee continued to monitor individual physician cesarean rates. "We’re going to continue to work on C-sections," promises Epley. "We’re going to make sure we maintain the progress we’ve made."