Arthur Ollendorff, MD
GRAHAM
ORANGE
NEW HANOVER
HOKE
PAMLICO
MACON
JACKSON
STOKES
FORSYTH
CRAVEN
DAVIE
PITT
MADISON
DURHAM
PERSON
CASWELL
ALAMANCE
GATES
WAKE
GUILFORD
YADKIN
SURRY
MECKLENBURG
UNION
PASQUOTANK
MARTIN
WASHINGTON
CAMDEN
CALDWELL
ALEXANDER
NC - 2016
TRANSYLVANIA
YANCEY
HAYWOOD
BURKE
EDGECOMBE
AVERY
JONES
RUTHERFORD
IREDELL
LENOIR
ASHE
Total Cesarean Rate by County
DAVIDSON
SAMPSON
BEAUFORT
HERTFORD
PERQUIMANS
HYDE
WILKES
TYRRELL
SCOTLAND
Primary Cesarean Rate – NC Hospitals 2017
Unadjusted Primary C/S Rate
40
35
30
25
20
15
10
0
Variation in NTSV Rates Among Provider Groups
at a NC Hospital
NTSV by Practice (Q1-Q3 2017)
40
35
30
25
15
10
0
Safe Reduction of Primary Cesarean Birth
(RPC) Initiative
• Statewide QI project to work with all birthing units in NC to decrease
unnecessary Cesarean Sections and maintain or improve the health of the
mother and newborn
• Expert team has developed specific goals for the project
• Demonstrate 100% compliance with all AIM RPC structure metrics
• Ensure that all NTSV women having a Cesarean Section have met the ACOG/SMFM
Cesarean Criteria for abnormal labor
• Achieve a statewide NTSV Cesarean rate at or below 20.0% and have each hospital
with an NTSV Cesarean rate at or below the Healthy People 2020 goal of 23.9%
• Demonstrate no change in newborn outcome by route of delivery measured by 5-
minute Apgar score < 7 and admission to the NICU stratified by reason for admission
Structure Measures – AIM RPC
S1: Patient, Family & Staff Support S1a: Has your hospital developed OB specific resources and protocols to
support patients, and family through an unexpected/ traumatic Cesarean?
S1b: Has your hospital introduced Principles of shared decision making?
S2: Unit Policy and Procedure Does your hospital have an up-to-date new labor guidelines policy and
procedure (reviewed and updated in the last 2-3 years) that provides a unit-
standard approach for providing labor support, freedom of movement, and
management protocols for labor challenges?
S3: EHR Integration Were some of the recommended tools for the Safe Reduction of Primary C/S
bundle (i.e. order sets, tracking tools) integrated into your hospital’s Electronic
Health Record system?
S4: Multidisciplinary Case Reviews for C/S Bundle Has your hospital established a process to perform multidisciplinary bundle
Alternate Measure for P3: C/S Bundle Compliance Rate reviews on a random sample of 10-20 charts/monthly (depending on hospital
size) for NTSV CS?
Indication for C-Section Algorithm Diagnose
YES
Failed Induction
Proceed with Cesarean
Section
Continue Titrating
NO
NO Pitocin
Induced Labor
or
Spontaneous Labor AROM
NO
AROM
Continue Augmentation
NO
Diagnose
Rest and Descend x1hr
Consider Augmentation: Arrest of Descent
Cervix Completely Urge to Push or Oxytocin, Assisted Delivery, if no Birth within 3hr for
Occiput Anterior? YES NO with descent noted,
Dilated +2 Station Position Change, Manual Natural or 4hr for Epidural,
Q30 min
Rotation Proceed with Cesarean
Section
YES
Push
Implement training/procedures
for identification and appropriate
interventions for malposition
No. 6
45%
Facility goal: 23.9%
40%
35%
Statewide goal: 20%
30%
25%
20%
15%
10%
5%
0%
Implement policy and protocols for encouraging movement in labor and intermittent monitoring for low
risk women
Perform monthly case reviews to identify consistency with dystocia and induction ACOG/SMFM checklists
Implement protocols and support tools for women who present in latent (early) labor to safely encourage
early labor at home
Share provider level measures with department (may start with blind data but quickly move to open
release)
Establish a project communication plan (at least monthly education and progress updates)
PLEASE PUT YOUR FACILITY
NAME ON TOP OF THE
INTERVENTION TRACKER AND
PLANNING SHEET