From the 2023 HVPA National Conference
Muna Shehadeh BS (JHAH), Asia Shaikh BS
Labor and Delivery Unit is one of the high acuities 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 delivery interval (DDI) is the timeline between a decision to conduct an emergency caesarean section and actual delivery of the baby. 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 decided on improvement project to decrease “decision to incision” times for Emergent Cesarean delivery to less than 30 minutes, in accordance with the American College of Obstetrics and Gynecology (ACOG) guidelines.
Develop an organization-wide policy on management of Crash Cesarean Section (CCS) to decrease DDI time and ensure STAT OB announcements are responded/attended within five minutes.
Structure Objective: By the end of June 2021, STAT OB policy will be 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 October 2021, the compliance to Decision-to-Delivery time will decrease by 20% from the baseline data in June 2021.
A retrospective cross-sectional study conducted involving inpatients who underwent emergency cesarean section. The study revealed that 57 cesarean section procedures were performed between January 2018 and June 2021. DDI ranged from 9 to 33 minutes with a mean DDI of 19.7 minutes. Great variation in DDI time was observed due to lack of standardization, clinical practice variations, system failure, communication failure, and lack of defined leadership role.
The team conducted A Root Cause Analysis and All challenges were identified, and action plan was implemented.
Significant reduction in both the DDI time variation and mean was observed following implementation of an organization-wide policy on emergency cesarean section (STAT OB) and applying evidence-based practice for CCS. Data was collected and analyzed for two periods: Period 1 before and period 2 after implementing Stat OB policy. The number of cases analyzed were 57 in period 1 and 20 in period 2. The DDI ranged between 9 and 33 minutes in period 1, and between 7 and 23 minutes in period 2. There was a significant reduction in mean DDI in Period 2 (11.8 ± 3.45 min) compared to period 1 (19.7 ± 6.02 min). No adverse events occurred. In addition, there was positive team dynamic, which enhanced effectiveness and encouraged good communication. The healthy environment allowed team members to do their best.
Safety of mother and child is critical during decision-to-deliver interval time. Developing and implementing an organization-wide policy is achievable and associated with shorter DDI time, improving communication, and team dynamics. Improvement can be sustained by regular compliance audit.
Every system is perfectly designed to achieve the results that it gets, designing the system in a way that staff can deliver care in a safer way and make it difficult for them to commit errors is the solution to have better and quality care.