8evlew of Slv8

CcLober 2010 Lo CcLober 2011

Slv8
W SepLember 2010 conference call reglsLraLlon
and lnlLlal Slv8 weblnar
lnformaLlon sesslon and overvlew of lnlLlaLlve
ldenLlfled paLlenL populaLlon and scope of lnlLlaLlve
(nS1v paLlenLs)
SeL alm of lncreaslng vaglnal dellvery raLe by 23
ueveloped acLlon plan Lo ldenLlfy pracLlces
assoclaLed wlLh hlgher raLes of vaglnal blrLh
W CcLober november 2010 prework for basellne
daLa
Slv8
W AcLlon lan
Labor sLaLus and cervlcal dllaLaLlon on admlsslon
resence of rlsk facLors for cesarean (uM AMA luC8
Macrosomla CbeslLy)
CesLaLlon age
Cervlcal rlpenlng agenLs used
MeLhods of lnducLlon or augmenLaLlon used
Labor supporL meLhods (lf any)
Mode of dellvery
rlmary lndlcaLlon for cesarean
MaLernal or neonaLal compllcaLlons
Slv8
W 1
S1
Learnlng Sesslon (!anuary 2011)
AcLlon plan overvlew and Leam bulldlng
ldenLlfylng key challenges Lo lncrease vaglnal dellvery raLes
LsLabllshlng areas of focus
W rospecLlve daLa collecLlon (leb uec 2011)
W 2
nd
Learnlng Sesslon (!une 2011)
Lxplorlng facLors conLrlbuLlng Lo cesarean raLe
LsLabllshlng sLraLegles Lo lncrease vaglnal dellvery raLe
1eams shared challenges and success and esLabllshed goals for
second half of Lhls lnlLlaLlve
W Weekly emall newsleLLers
W MonLhly weblnar meeLlngs
2684
2396
2670
2609
2391
2346
2331 2337
000
300
1000
1300
2000
2300
3000
3300
4000
4300
3000
8asellne lebruary March Aprll May !une* !uly* AugusL*
1he Io|nt Comm|ss|on Cesarean kate
!olnL Commlsslon 8aLe
W ulabeLes (any Lype)
W luC8
W MaLernal age
greaLer Lhan/equal
Lo 33
W PyperLenslve
dlsease
W Macrosomla (LlW
greaLer Lhan 4000g)
W CbeslLy
1ota| number of women
w|th 1+ r|sk factors by
month (a|| de||very
methods)
8ase||ne S24 (2693)
Iebruary 322 (3179)
March 338 (3130)
Apr|| 323 (3220)
May 2SS (2787)
Iune 232 (2648)
Iu|y 219 (2648)
2477
2399 2412
2367
2216
2198
2164
2144
1983
1823
1932
1866
1906
1920
1760
1867
3817
3634
3462
3407
3020
2974
3288
2797
000
300
1000
1300
2000
2300
3000
3300
4000
4300
3000
8asellne lebruary March Aprll May !une* !uly* AugusL*
C
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Cesarean kates by k|sk
CvL8ALL C/S 8A1L
C/S 8A1L nC C/S 8lSk lAC1C8S
C/S 8A1L 1+ C/S 8lSk lAC1C8S
3031
3133
3208
4816
3022
4926
4807
4936
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
8asellne lebruary March Aprll May !une* !uly* AugusL*
9
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CI 91S NC1 IN LA8Ck A1 ADMISSICN
Cl 1S nC1 ln LA8C8 A1 AuMlSSlCn
CLSA8LAn 8A1L lC8
1S nC1 ln LA8C8 A1
AuMlSSlCn
3219
CLSA8LAn 8A1L lC8
1S ln LA8C8 A1
AuMlSSlCn
14S2
4363
3032
2137
CLSA8LAn 8A1L
4000
2189
1221
CLSA8LAn 8A1L
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
CLkVICAL DILA1ICN A1 ADMISSICN NC1 IN LA8Ck
0
12
3+
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
CLkVICAL DILA1ICN A1 ADMISSICN IN LA8Ck
0
12
3+
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
nonreassurlng
feLal sLaLus
resumed
cephalopelvlc
dlsproporLlon
lallure Lo
progress (1sL
sLage C/S)
MalpresenLaLlon ChorloamnlonlLls lalled operaLlve
vaglnal dellvery
lallure Lo
descend (2nd
sLage C/S)
CLher
9kIMAk INDICA1ICN ICk CLSAkLAN
8asellne
lebruary
March
Aprll
May
!une*
!uly*
AugusL*
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
nonreassurlng
feLal sLaLus
resumed
cephalopelvlc
dlsproporLlon
lallure Lo
progress (1sL
sLage C/S)
MalpresenLaLlon ChorloamnlonlLls lalled operaLlve
vaglnal dellvery
lallure Lo
descend (2nd
sLage C/S)
CLher
C]S INDICA1ICN AMCNG 1+ C]S kISk IAC1CkS
8asellne
lebruary
March
Aprll
May
!une*
!uly*
AugusL*
CLSA8LAn 8lSk lAC1C8S
W ulabeLes (any Lype)
W luC8
W MaLernal age greaLer Lhan/equal Lo
33
W PyperLenslve dlsease
W Macrosomla (LlW greaLer Lhan
4000g)
W CbeslLy
346
243
409
1167
083
1134
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
ulabeLes (any Lype) luC8 MaLernal age greaLer
Lhan/equal Lo 33
PyperLenslve dlsease Macrosomla (LlW
greaLer Lhan 4000g)
CbeslLy
C]S kISk IAC1CkS ALL MCN1nS
ALL uA1A
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
nonreassurlng
feLal sLaLus
resumed
cephalopelvlc
dlsproporLlon
lallure Lo
progress (1sL
sLage C/S)
MalpresenLaLlon ChorloamnlonlLls lalled operaLlve
vaglnal dellvery
lallure Lo
descend (2nd
sLage C/S)
CLher
C]S INDICA1ICN AMCNG 91S WI1n NC C]S kISk IAC1CkS
8asellne
lebruary
March
Aprll
May
!une*
!uly*
AugusL*
2798
2433
1776
2222
2299
2121
1961
896
4093
3043 3047
4074
4828
3483
3490
4179
2487
2348
2897
3704
2299
4091
2333
4179
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000

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DILA1ICN WnLN I19 DIAGNCSLD
03
46
7+
000
1000
2000
3000
4000
3000
6000
7000
8000
9000
10000
uCuLA SuC81lvL
lAMlL?/l8lLnu
Lluu8AL 1PL8ALu1lC
8LS1
CnL 1C CnL
nu8SlnC CA8L
A8Ln1L8AL
Aln
MLulCA1lCn
nCnL
uCCuMLn1Lu
LA8Ck SU99Ck1 ML1nCDS
8asellne
lebruary
March
Aprll
May
!une*
!uly*
AugusL*
Why 1hlnk 8lg?
W 1he work you have already accompllshed
W 1he work you wlll be able Lo accompllsh
W WhaL oLhers Lhlnk abouL your work
APA
uMA
uP
SLaLe leglslaLure
8C8S and Lhe Cfflce for 8ural PealLh and
CommunlLy Care
hase 2 of Slv8
W 8ased on evldence
W 8ased on accumulaLed experlence
W Comblne Lhls lnlLlaLlve wlLh ongolng pro[ecLs
W uevelop a focused acLlon honlng ln on key
polnLs
Labor and cervlcal dllaLaLlon sLaLus on admlsslon
aLlenLs wlLhouL rlsk facLors for cesarean
hase 2 Slv8
W uaLa seL revlslons
SlgnlflcanL reducLlon ln daLa polnLs collecLed
Conslder every paLlenL
SupporLs Lhe workls noL 1PL work
oLenLlal uaLa CollecLlon 1ool
W ls Lhe paLlenL ln labor (regular conLracLlons wlLh cervlcal
change)? ?es no
W Are any of Lhe followlng condlLlons documenLed ln Lhe charL?
ulabeLes PyperLenslve dlsease luC8 Macrosomla (LlW 4000g)
MaLernal age 33 CbeslLy
W Cervlcal exam on admlsslon ____
W Mode of uellvery
SponLaneous vaglnal blrLh CperaLlve vaglnal
Cesarean secLlon 1
sL
sLage Cesarean secLlon 2
nd
sLage
oLenLlal uaLa CollecLlon 1ool
W CesLaLlonal age 37
0/7
38
6/7
39
0/7
40
6/7
41
0/7
W rlmary lndlcaLlon for Cesarean
nonreassurlng feLal sLaLus lallure Lo progress (1sL sLage C/S)
Cervlcal dllaLlon aL lasL exam _________cm
lallure Lo descend (2
nd
sLage C/S) CLher
W MaLernal CompllcaLlons
ChorloamnlonlLls 3
rd
/4
Lh
degree lac osLparLum hemorrhage
LndomeLrlLls uLerlne rupLure
W neonaLal CompllcaLlons
Apgar aL 3 mlnuLes 6 Shoulder dysLocla ueaLh/SLlllblrLh
Admlsslon for nonsLandard newborn care CLher