Improve Decision -to- Delivery Interval Time through Implementation of “STAT OB” Response Team (As part of the CUSP Improvement Project 2021 in Labor and Delivery Unit)

From the 2022 HVPA National Conference

Muna Shehadeh BS (Johns Hopkins Aramco Healthcare), Asia Ashaikh BS

Introduction

Labor and Delivery Unit is one of the high acuity closed units where continuous monitoring and one-to-one care is provided. Sudden and unexpected emergencies may arise without any warning signs which require an immediate cesarean section delivery to save the life of the mother and baby and to reduce the risk of possible associated morbidity.

Decision -to- Delivery Interval (DDI) is the time line between a decision to conduct an emergency caesarean section and actual delivery of the baby. The current standard of Decision-to- Delivery interval accepted by ACOG and NICE is No more than 30 minutes. Prolong DDI constitute a third phase delay in provision of emergency obstetric care. Intervention designed to minimize DDI are vital, in attempt to prevent maternal morbidity and neonatal morbidity and mortality.

CUSP Multidisciplinary team identified Emergency Cesarean Section as an opportunity for improvement.

Aim

The project Aim is to reduce the Decision – to – Delivery time by developing STAT OB policy on management of Crash Caesarian Section to ensure that all relevant team member are responding within less than 5 minutes .

Objectives

Structure Objective
By the end June 2021 there will be STAT OB policy developed and polished in JHAH.

Process Objective
By the end of June 2021 the Response time of STAT OB team to be Less than 5 minutes.

Outcome Objective
By the end of October2021 the compliance to Decision – to – Delivery time will be decreased by 20 %.

Methodology

A specialized multidisciplinary team was convened with representation from OB team staff (OBConsultant, OB staff physician, Midwives, OB Anesthesiologist, Anesthesia technician, Neonatologist, NICU nurse and 2H OR Nurses) aligned with process improvement expert and Followed the PDCA methodology:
Retrospective cross-sectional study of inpatient cases who underwent emergency caesarean section ,Data was collected From January 2020 to October 2021 revealed total of 78 cases of Category E1 Emergency cesarean section which constituted roughly 14% of the total number of cesarean sections (557). The current practice was reviewed and Root Cause Analysis was conducted. Major challenges identified was due to: Epic C/Section case request: It was lengthy, time consuming and does not always appear in 2H OR screen , Activated emergency alarm can only be heard within 2J and 2H units, therefore the team members outside these units are only alerted by phone, challenging with Preparing and administering essential pre-operative medication, Communication between team members ,Variation in practice and Lack of policy to standardize the response and clarify roles and responsibilities of the team members.

Based on the gaps identified during the RCA action plan was developed and included: Create Stat OB policy to standardize care processes. Stat OB will be announced hospital wide , conducting Crash cesarean section simulation , Create crash-C/S case request Button in Epic , All essential medications are made available and overridden in Omnicel , Two Crash Cesarean section trays equipped with all necessary bitems may be required for crash cesarean section are made ready.

Result

Continuous monitoring on compliance to the interventions and a performance Results showed significant improvement
· Reducing the DDI average time from 19.7 min to 10.3 minutes, a decreased by 47%
· The response time of STAT OB team is within 3 minutes.

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