(762) Respectful Care and Safe Reduction of NTSV Cesarean Delivery Through Standardized QI Interventions

Objective:
Racial disparities persist in New York, with Black birthing people facing nearly triple the mortality of White counterparts. In 2024, NTSV cesarean rates at NYU Langone—Long Island exceeded benchmarks: 47.1% in Black and 37.4% in Asian patients. This QI initiative aimed to reduce rates by 36% and 20%, targeting ≤30% overall.

Study Design:
This single-site, multidisciplinary QI project began in September 2023 with baseline data revealing elevated and racially disparate NTSV cesarean rates. In November 2024, provider education was launched via Grand Rounds, emphasizing evidence-based labor management and documentation. Reinforcement included case reviews, education sessions, safety huddles, and high-reliability organization rounds. A Race & Ethnicity Workgroup was added in March 2025. The intervention aligned with NYSPQC Respectful Care drivers (Figure 1). Outcomes were tracked monthly, including race-stratified NTSV rates and balancing metrics (QBL >1,000 mL and PC-06, unexpected newborn complications).

Results:
By June 2025, the overall NTSV rate declined to 22.8%, with 6 of the last 7 months below 30%. Rates fell notably among Black (61.5% to 38.7%) and Asian (44.0% to 17.5%) patients, narrowing the Black–White gap from 34.3 to 14.2 points (Figure 2). Balancing metrics remained stable: QBL at 3.8–10.1%; PC-06 at 26.8–37.5 per 1,000 births.

Conclusion:
Equity-focused, standardized labor interventions safely reduced overall and race-stratified NTSV cesarean rates. The strategy, rooted in targeted universalism and respectful care, supports sustainable improvement. Future analysis will explore comorbidities and cesarean indications by race to identify ongoing opportunities for equitable care.