Sandra Dunn1, Ann E Sprague2, Deshayne B Fell3, Jessica Dy4, JoAnn Harrold5, Bernard Lamontagne6, Mark Walker7. 1. BORN Ontario (Better Outcomes Registry and Network), Ottawa ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa ON; Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON. 2. BORN Ontario (Better Outcomes Registry and Network), Ottawa ON; Children's Hospital of Eastern Ontario Research Institute, Ottawa ON. 3. BORN Ontario (Better Outcomes Registry and Network), Ottawa ON. 4. Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa ON; OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON. 5. Children's Hospital of Eastern Ontario Research Institute, Ottawa ON; Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Department of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa ON. 6. Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Champlain Local Health Integration Network, Ottawa ON. 7. BORN Ontario (Better Outcomes Registry and Network), Ottawa ON; Champlain Maternal Newborn Regional Program (CMNRP), Ottawa ON; Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa ON; OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa ON; Tier 1 Research Chair, Perinatal Epidemiology, University of Ottawa, Ottawa ON.
Abstract
OBJECTIVE: Elective repeat Caesarean section (ERCS) for low-risk women at < 39 weeks' gestation has consistently been associated with increased risks to the neonate, including respiratory morbidity, NICU admission, and lengthier hospital stays than ERCS at 39 to 40 weeks' gestation. The objective of this quality improvement project was to reduce high rates of ERCS < 39 weeks across the Eastern Ontario region. METHODS: All hospitals within the region providing care during labour and birth (n = 10) were asked to participate. Representatives from each hospital received information about their site-specific rates and knowledge-translation resources to assist them with the project. A benchmark rate for ERCS < 39 weeks was set at 30%. The rates of ERCS < 39 weeks were calculated for two different times (the 2009-2010 and 2010-2011 fiscal years) and the relative difference and 95% confidence intervals were calculated to quantify the magnitude and statistical significance of any change. Qualitative interviews were completed with key informants from each hospital. RESULTS: The proportion of ERCS at < 39 weeks' gestation across the region in the fiscal year 2010-2011 (n = 197/497; 39.6%) was significantly decreased (relative difference: -21%; 95% CI -31% to -8%, P = 0.002) from the previous fiscal year 2009-2010 (n = 229/459; 49.9%). A number of barriers to, and facilitators of, practice change were identified. CONCLUSION: A reduction in the rate of ERCS < 39 weeks among low-risk women was achieved across the region. Awareness of the issue, possession of site-specific data, and agreement about the evidence and the need for change are critical first steps to improving practice.
OBJECTIVE: Elective repeat Caesarean section (ERCS) for low-risk women at < 39 weeks' gestation has consistently been associated with increased risks to the neonate, including respiratory morbidity, NICU admission, and lengthier hospital stays than ERCS at 39 to 40 weeks' gestation. The objective of this quality improvement project was to reduce high rates of ERCS < 39 weeks across the Eastern Ontario region. METHODS: All hospitals within the region providing care during labour and birth (n = 10) were asked to participate. Representatives from each hospital received information about their site-specific rates and knowledge-translation resources to assist them with the project. A benchmark rate for ERCS < 39 weeks was set at 30%. The rates of ERCS < 39 weeks were calculated for two different times (the 2009-2010 and 2010-2011 fiscal years) and the relative difference and 95% confidence intervals were calculated to quantify the magnitude and statistical significance of any change. Qualitative interviews were completed with key informants from each hospital. RESULTS: The proportion of ERCS at < 39 weeks' gestation across the region in the fiscal year 2010-2011 (n = 197/497; 39.6%) was significantly decreased (relative difference: -21%; 95% CI -31% to -8%, P = 0.002) from the previous fiscal year 2009-2010 (n = 229/459; 49.9%). A number of barriers to, and facilitators of, practice change were identified. CONCLUSION: A reduction in the rate of ERCS < 39 weeks among low-risk women was achieved across the region. Awareness of the issue, possession of site-specific data, and agreement about the evidence and the need for change are critical first steps to improving practice.
Entities:
Keywords:
Caesarean section; Quality assurance; audit and feedback; knowledge translation; perinatal data
Authors: Jessica Reszel; Sandra I Dunn; Ann E Sprague; Ian D Graham; Jeremy M Grimshaw; Wendy E Peterson; Holly Ockenden; Jodi Wilding; Ashley Quosdorf; Elizabeth K Darling; Deshayne B Fell; JoAnn Harrold; Andrea Lanes; Graeme N Smith; Monica Taljaard; Deborah Weiss; Mark C Walker Journal: BMJ Qual Saf Date: 2019-02-16 Impact factor: 7.035
Authors: Sandra Dunn; Ann E Sprague; Jeremy M Grimshaw; Ian D Graham; Monica Taljaard; Deshayne Fell; Wendy E Peterson; Elizabeth Darling; JoAnn Harrold; Graeme N Smith; Jessica Reszel; Andrea Lanes; Carolyn Truskoski; Jodi Wilding; Deborah Weiss; Mark Walker Journal: Implement Sci Date: 2016-05-04 Impact factor: 7.327
Authors: Sandra Dunn; Andrea Lanes; Ann E Sprague; Deshayne B Fell; Deborah Weiss; Jessica Reszel; Monica Taljaard; Elizabeth K Darling; Ian D Graham; Jeremy M Grimshaw; JoAnn Harrold; Graeme N Smith; Wendy Peterson; Mark Walker Journal: BMC Health Serv Res Date: 2019-12-27 Impact factor: 2.655