Engaging Residents in Quality Improvement: A Multidisciplinary Collaboration to Decrease the Primary Cesarean Delivery Rate at a New Academic Medical Center

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BACKGROUND:Our facility performs more than 9,000 deliveries per year, with a primary cesarean birth rate of 35% and is the primary teaching site for a new Ob/Gyn residency program. An innovative curriculum includes a formal course in quality improvement methods for new faculty, and active participation of all residents in a QI project. In an effort to decrease the primary cesarean birth rate, a multidisciplinary QI project was developed.METHODS:The team was led by two community faculty members and included two residents, nursing and hospital administration. Interventions included mandatory completion of a FHR course, provider education on current terminology and recommended interventions, and monthly reporting of cesarean delivery rates. The team used a fishbone analysis of the steps leading to a cesarean delivery to create a data collection checklist. Charts were reviewed by the residents to confirm the indication for cesarean delivery along with other pertinent variables.RESULTS:The primary cesarean birth rate decreased from 35% in the first quarter of 2015 to 27% in the first quarter of 2016, a 24% decrease. The project team continues to meet quarterly to discuss ongoing activities necessary to maintain and increase the improvement observed in the initial quarter. Residents and faculty report a strong sense of accomplishment as a result of the project, and an interest in continued participation in QI activities.DISCUSSION:Interdisciplinary partnerships between OBGYN residents, faculty and hospital administration/staff to develop and implement quality improvement projects can improve patient care and provide learners with the knowledge and expertise to engage in quality projects in their future practice.

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