Using the medical audit cycle to reduce cesarean section rates

Robson, Michael; Scudamore, I. W.; Walsh, Sheila

doi:10.1016/s0002-9378(96)70394-0

Cited by 125 publications

(110 citation statements)

References 19 publications

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“…El aumento progresivo en la tasa de cesáreas nos lleva a analizar las diferentes situaciones y grupos de mujeres en los que ha aumentado la tasa de cesáreas para poder intervenir y frenar el aumento de las mismas, por eso la importancia de buscar sistemas de clasificación con los que realizar comparaciones (8)(9)(10).…”

Section: Discussionunclassified

“…Esta clasificación está basada en paráme-tros bien definidos y fáciles de controlar de cada mujer y su embarazo en lugar de la indicación de la cesárea, evitándose así mucha confusión, discrepancias y variabilidad inherente a la indicación de una cesárea. La Clasificación de Diez Grupos propuesta por Robson puede aplicarse internacionalmente y permite comparaciones en el tiempo de una misma unidad asistencial y entre distintas unidades (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Tabla I Clasificación De Robsonunclassified

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Uso de la clasificación de Robson en un Hospital Comarcal de España para reducir la tasa de cesáreas

Redondo

Fuentes

Denaroso

et al. 2016

Rev. chil. obstet. ginecol.

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Ginecología. Huércal-Overa (Almería). Andalucía. España. RESUMENAntecedentes: En las últimas décadas se ha producido un incremento extraordinario en la incidencia de cesáreas en todos los países desarrollados. La tasa de cesáreas en España registrada por el Ministerio de Sanidad es de 24,9%. Objetivo: Analizar las cesáreas en el Hospital La Inmaculada, mediante la clasificación de Robson para comparar con otros hospitales, tanto nacional como internacionalmente y establecer las intervenciones posibles para reducir la tasa de cesáreas. Métodos: Se realiza una auditoría retrospectiva de cesáreas en función de la clasificación de diez grupos establecida por Robson desde el 1 enero de 2006 al 31 de diciembre de 2013. Resultados: Se han analizado 9337 partos y 1507 cesáreas con un 16,14%. En la contribución al porcentaje de cesáreas en primer lugar con 25,2% corresponde a nulíparas con un feto único en presentación cefálica, de 37 semanas o más de embarazo. En segundo lugar las multíparas con al menos una cesárea previa, con un feto único en presentación cefálica, de 37 semanas o más de embarazo con 19,4%. En este grupo se ha realizado un 42,2% de cesáreas. En tercer lugar nulíparas con un feto único en presentación cefálica, de 37 semanas o más de embarazo, que han iniciado el parto de forma espontánea con 17,4%. Conclusiones: El aumento de cesáreas en las últimas décadas hace necesario la realización de auditorías mediante un sistema de clasificación, como Robson, para establecer los grupos en los que es posible disminuir el número de cesáreas. PALABRAS CLAVES: Cesáreas, clasificación de Robson, calidad de atención, auditoría médica SUMMARY Introduction:In recent decades there has been a dramatic increase in cesarean section rate in all developed countries. The cesarean section rate in Spain, registered by the Ministry of Health was 24.9%. Objective: To analyze cesarean section rate in Inmaculada Local Hospital, using Robson's classification to compare it with other hospitals, both at national and international level and establish potential interventions to reduce such rate. Methods: A cesarean section rate retrospective audit was performed according to Robson´s classification, from 1st January 2006 to 31st December 2013. Results: 9337 deliveries and 1507 cesareans were analyzed on that period of time. The cesarean rate was 16.14%. Nulliparous women with a singleton pregnancy in cephalic presentation at 37 weeks or more and undergo a labor induction before the onset of labor represent the first group of the cesareans with 25.2% of the total. In second place comes multiparous women with at least one previous cesarean section with a singleton pregnancy in cephalic presentation, 37 weeks or more, representing 19.4% of the total cesareans. This group had a 42.2% cesarean rate. In third place (17.4%) we had nulliparous women with a singleton pregnancy in cephalic presentation, 37 weeks REV CHIL OBSTET GINECOL 2016; 81(2): 99 -104 REV CHIL OBSTET GINECOL 2016; 81(2) 100

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Section: Discussionunclassified

Section: Tabla I Clasificación De Robsonunclassified

Uso de la clasificación de Robson en un Hospital Comarcal de España para reducir la tasa de cesáreas

Redondo

Fuentes

Denaroso

et al. 2016

Rev. chil. obstet. ginecol.

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“…Based on the literature for evidence-based interventions to reduce CD, the various strategies aimed at changing physicians' behavior can be grouped into i) feedback and audit, and ii) quality of care interventions (in addition to the more multifaceted approaches) [51] . Feedback and audit are mainly achieved by mandatory second opinions [52] , internal and external peer review of medical records for trial of labor outcome, Vaginal Birth After Cesarean (VBAC), births outcomes and results sharing [53,54] .…”

Section: Physicians Behavior and Practicesmentioning

confidence: 99%

Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

Hou¹,

Rakhshani

Iunes³

2014

JHA

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Background: Annually 6.2 million unnecessary Cesarean Deliveries (CD) are performed globally. Such high unnecessary CD rate is a concern not only due to the additional financial burden it places on the health system, but also because the quality of care could be compromised. There is an even more imperative need to reduce elective surgeries in moving towards the Universal Health Coverage (UHC), to ensure the ever stretched resources are effectively channeled for the best health outcomes. Methods:The paper uses a case study method. China and Brazil were selected primarily due to their alarmingly high number and percentage of the CD rate. Systematic literature review was conducted and the analyses were structured based on the framework "Determinants of High Cesarean Delivery Rates", developed by the authors. Results:In China and Brazil, cultural belief, fear of labor pain and patient's perception regarding quality of care may play a role in the patient's preference for CD but these perceptions are shaped by their health care providers as well. The principal-agent relation comes into play as the health professionals can modify perceived needs of their patients. Availability of health insurance to mothers, physicians' preference for convenient working hours, and payment incentives for performing higher yielding Cesarean procedures are driving the high CD rate phenomena in China and Brazil.Understand the social determinants of CD and using various instruments to change women's perceptions of birthing options and physicians' behaviors are critical in managing the CD rate. Conclusion:In the context of the rapid movement towards UHC, the evidence presented in this paper supports the call for implementing complementary policy interventions and regulation to ensure minimal efficiency loss due to resources being diverted to unnecessary procedures or hospital stays.

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“…Maybe the government focus on efficiency in order to save money in the NHS will mean that things will change in the future. However, my reading of the literature is that a reduction in a hospital CSR only occurs where there are strong leaders who are determined to reduce that rate (Myers et al 1993;Johnson and Ansell 1995;Robson et al 1996;Flamm et al 1998). Swedish obstetricians reduced their national CSR after agreeing it was too high (Nielsen et al 1994).…”

mentioning

confidence: 99%

“…Audit caesarean sections weekly and use Robson's groups to analyse your statistics; identify the major contribution to the CSR; deal with the problem and monitor progress (Robson et al 1996).…”

mentioning

confidence: 99%

The rising caesarean section rate: A loss of obstetric skill?

Savage

2007

Journal of Obstetrics and Gynaecology

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Using the medical audit cycle to reduce cesarean section rates

Cited by 125 publications

References 19 publications

Uso de la clasificación de Robson en un Hospital Comarcal de España para reducir la tasa de cesáreas

Uso de la clasificación de Robson en un Hospital Comarcal de España para reducir la tasa de cesáreas

Factors associated with high Cesarean deliveries in China and Brazil - A Call for reducing elective surgeries in moving towards Universal Health Coverage

The rising caesarean section rate: A loss of obstetric skill?

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