LAUSR

56 Nurse-specific cesarean rates: why and how Naomi H. Greene, Jolene Kilcoyne, Adam Grey, Susan G. Hawkes, Joyce K. Edmonds, Kimberly D. Gregory Cedars-Sinai Medical Center, Los Angeles, CA, Boston College, Chestnut Hill, MA OBJECTIVE: Among nationwide efforts to safely reduce nulliparous, term, singleton, vertex (NTSV) cesarean rates, the value of labor support from nurses has prompted discussion of the need to consider “nurse-specific cesarean rates”. Calculation of nurse-specific rates is problematic due to the duration of labor and the difficulty of determining which nurse was primarily responsible for the delivery route. We present our strategy for deriving nurse-specific rates, using information available in the electronic medical record (EMR). STUDY DESIGN: Excluding scheduled cesarean deliveries, for every NTSV delivery in FY18 through April we extracted delivery route, cesarean indication, delivery time, time of maximum cervical dilation, time of first and last vital sign check for each nurse, time of first documentation of pushing and name of the delivery nurse from the EMR. We calculated the number of minutes between first and last vital sign check and summed all minutes spent with the patient for each nurse. The nurse spending the most time with the patient prior to complete dilation was designated ‘Labor Nurse’. The nurse who first documented pushing with the patient was designated ‘Pushing Nurse’. We present results for nurses with at least 10 NTSV deliveries during the study period. RESULTS: There were 2280 NTSV deliveries and 142 nurses provided care during labor; 85 met inclusion criteria. Figures 1 and 2 show the nurses with the 10 highest and lowest cesarean rates by labor vs pushing nurse role. Sharing the results with staff nurses, we were able to create a list of ‘mentor nurses’ for labor and pushing, and also identified a group of nurses that might benefit from remediation through observing mentor nurses. The data extracted from the EMR to carry out these analyses has been made into an auto-generated weekly report. CONCLUSION: Calculating nurse-specific cesarean rates is complex. We describe a feasible method based on existing information from the EMR. The data abstraction process can be automated and shared for ongoing quality improvement efforts.