Observational studyHealth services research2021
Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points.
Observational study in Health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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Who cites it
4 citing papers in PubMed, 10 citations in OpenAlex.
- Employee Net Promoter Score Links Nursing Satisfaction to Quality of Care Before and During the COVID-19 Pandemic.Journal of nursing management · 2026Article
- Work Experience and Attitudes About Birth in Relation to Nurses' Cesarean Rates for Women With Low-Risk Pregnancies.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2025Article
- Shared Decision Making in Perinatal Care.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2024Article
- Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points.Health services research · 2021Observational
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the variability in the cesarean delivery (CD) rates of individual labor and delivery nurses compared with physicians at three attribution time points. DATA SOURCES: Medical record data from nine hospitals in Washington State from January 2016 through September 2018. STUDY
designRetrospective, observational cohort design using an aggregated database of birth records. DATA COLLECTION/EXTRACTION
methodsChart-abstracted clinical data from a subset of nulliparous, term, singleton, vertex births attributed at admission, labor management, and delivery to nurses and physicians. Two classification methods were used to categorize nurse- and physician-level CD rates at three attribution time points and the reliability of these methods compared. PRINCIPAL
findingsThe sample included 12 556 births, 319 nurses, and 126 physicians. Overall, variation in nurse-level CD rates did not differ significantly across the three attribution time points, and the extent of variation was similar to that observed in physicians. However, agreement between attribution time points varied between 35 percent and 65 percent when classifying individual nurses into the top and bottom deciles. The average reliability of nurse-level CD rates was 32 percent at admission (IQR 22.0 percent to 38.7 percent), 32.6 percent at labor (IQR 23.1 percent to 40.9 percent), and 29.3 percent (IQR 20.9 percent to 35.8 percent) at delivery. The average reliability of physician-level CD rates was higher: 54.2 percent (IQR 38.7 percent to 71.4 percent) at admission, 62.5 percent (IQR 49.0 percent to 79.6 percent) at labor management, and 66.1 percent (IQR 53.7 percent to 81.2 percent) at delivery.
conclusionFeedback on nurse-level CD rates as part of routine clinical quality audits can provide insight into nurse performance in the context of other individual-level and unit-level information. To reliably distinguish individual nurse performance, larger sample sizes are needed.
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