A multi-approach management intervention can lower C-section rate trends: The experience of a Third Level Referral Center de Belvis A.G., Neri C., Angioletti C., Carducci B., Ferrazzani S., Lanzone A., Caruso A.

Objective: To report the experience developed in a Third Level Referral Center in performing a multifaceted intervention strategy to reduce Caesarian Sections (CS) rate. A comparison of our results with the performance of the best Italian hospitals for number of deliveries and CS has been performed. Methods: A monitoring system was set up, based on a prospective collection of all deliveries from 2013 to 2017, according to Robson’s classification. Data have also been collected retrospectively at a regional and national level to compare our results to other institutions. The multi-approach intervention consisted of evidence based tools: process management, training, multiprofessionalism, development of planning and control systems, continuous monitoring, audit and feedback. Results: The percentage of primary CS decreased from 26.71% in 2013 to 15.03% in 2017 (RR adjusted considering the regional average: 0.87 in 2013; 0.57 in 2017, p < .001). A raise of 19.76% in the annual volume of deliveries was registered. Such results have also been confirmed after comparing to the best performing Italian centers. From 2013 to 2016 the percentage of primary CS decreased from 27.02% to 18.04% (RR adjusted considering the regional average: 1.04 in 2013, p > .05; 0.74 in 2016, p < .001), while there was an increase in the annual volume of deliveries from 3,311 to 4,219. Conclusions: Our study confirms that multifaceted interventions can strengthen a continuous quality and safety improvement approach. This is of crucial relevance in the obstetric field and in the Italian country, where overall performance in CS needs to be improved.