Implementation of Team Communication and Nurse Feedback to Reduce Cesarean Rates

Abstract

Objective: To implement an interprofessional communication tool before non-emergent cesarean births and evaluate individual nurse cesarean rates for women with low-risk pregnancies. Design: A quality improvement initiative using four Plan–Do–Study–Act cycles over a 6-month period in 2022. Setting: U.S. Mid-Atlantic maternity unit with a Level III NICU during the COVID-19 pandemic. Patients/Participants: Nulliparous women with term singleton pregnancies in which the fetus was in vertex presentation (NTSV) who underwent non-emergent cesareans (N = 868) and their interprofessional clinical teams, including nurses, certified nurse midwives, attending physicians, and resident physicians. Interventions: Implementation of a validated, adapted communication tool for use by the clinical team before non-emergent cesareans. We added individual nurse cesarean rates for women with NTSV pregnancies to the existing clinical audit and feedback process. We collected compliance data through chart reviews and an Epic report. Main Outcome Measure(s): Rates of compliance with use of the tool and variation in individual nurse cesarean rates for women with NTSV pregnancies. Results: Compliance with use of the tool averaged 62% and peaked at 77% during active education efforts but declined to 33% after implementation. We noted wide variation in individual nurse cesarean rates for women with NTSV pregnancies (0.00%–45.45%) among nurses who managed 10 or more eligible births over 5 months. We identified positive outliers or nurses who consistently had low cesarean rates. Conclusion: Achieving high compliance with the use of an interprofessional communication tool before non-emergent cesareans requires sustained education and engagement. Integrating the communication tool into existing workflows may enhance its long-term effect. The variability in individual nurse cesarean rates that we found suggests a need for further investigation into nursing practices that support physiological birth and reduce unnecessary cesareans.