October 18th, 2018

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Impact of a Quality Improvement Initiative on the Episiotomy Rate at a Community Hospital
Authors:  Daryl Wieland, M.D., MSMI, Maureen Burke, M.D., Andrew Rausch, M.D., Donna Bowman, DNP, FNP-BC, RNC-OB, and Paul Bobby, M.D.
  OBJECTIVE: To evaluate if a quality improvement initiative using group education and individual audit and feedback could reduce episiotomy rates at a community hospital.

STUDY DESIGN: A quality improvement intervention was initiated in 2013. Physician education including department-wide presentations and dissemination of literature addressed the clinical rationale for avoiding routine use of episiotomy for vaginal delivery. During the active intervention we audited episiotomy rates quarterly and provided a confidential report to individual physicians along with the departmental average. We compared the rate in 2013 to a 9-month period prior to the intervention and a 12-month period after the intervention.

RESULTS: A total of 3,408 vaginal deliveries occurred during the study. Preintervention, 277 episiotomies were performed in 1,002 deliveries (27.6%); during the intervention 231 episiotomies in 1,182 deliveries were performed (19.5%); and after the intervention 223 episiotomies in 1,224 deliveries were performed (18.2%). The decrease in episiotomy rate after the intervention was statistically significant (27.6% vs. 19.5%, p<0.01) and this decline was sustained an additional year following the intervention (27.6% vs. 18.2%, p<0.01).

CONCLUSION: A quality intervention that includes group education with audit and feedback is effective at decreasing routine episiotomy rates. This result persisted 1 year after the intervention was completed.
Keywords:  episiotomy, community hospitals, feedback, obstetrics, patient safety, quality improvement
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