Clinical performance management through inclusive critical analysis – impact on the highest caesarean section rate in England and Wales

Introduction Rising Caesarean section rates are a global concern. In the last 15 years the rate of Caesarean section birth in England has doubled to approximately 150 000 operations per year without any obvious improvement in outcomes for babies. While the national average Caesarean section rate is 24%, one of our units was consistently recording rates in excess of 30%. Study The authors introduced a live and continuous prospective audit tool aimed at clinical performance management. As a part of the audit tool, a peer-review meeting was introduced every morning in the delivery suite. The meeting was chaired by the obstetric consultant and attended by all obstetric, anaesthetic and midwifery staff on duty. The details of all operative deliveries and predefined adverse incidents in the last 24 h were formally presented by the outgoing registrar and was critically analysed within a learning environment. The discussions were proforma-led to capture demographic details, clinical decision making as well as a clinical performance outcomes such as decision-delivery intervals and neonatal admissions. The meetings provided an excellent opportunity for the trainees to improve their insight and clinical judgement. The multidisciplinary input improved quality of clinical care. Result It was found that the Caesarean section rate has reduced to 22% within 6 months. Reduced Caesarean section rates led to improvements in each of the three domains of quality of care namely safety, effectiveness and patient experience. Conclusion Live and organised continuous peer review of obstetric practice can reduce Caesarean section rate without compromising maternal and fetal safety.