Response times for emergency cesarean delivery: use of simulation drills to assess and improve obstetric team performance

• Published in: Journal of perinatology Vol. 33; no. 4; pp. 259 - 263
• Main Authors: Lipman, S S, Carvalho, B, Cohen, S E, Druzin, M L, Daniels, K
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-04-2013; Nature Publishing Group
• Subjects: 631/443/494; 692/700/565/545; Anesthesia; Anesthesiology; Cesarean section; Cesarean Section - education; Cesarean Section - methods; Delivery Rooms - manpower; Drills; Emergencies; Emergency response; Emergency vehicles; Female; Gynecology; Hospitals; Humans; Intensive Care, Neonatal - manpower; Intensive Care, Neonatal - methods; Intensive Care, Neonatal - standards; Labor; Management; Maternal & child health; Medical personnel; Medicine; Medicine & Public Health; Models, Educational; Multidisciplinary teams; Obstetrics; Organizational Policy; original-article; Patient Care Team - standards; Patient Simulation; Pediatric Surgery; Pediatrics; Pregnancy; Quality Improvement; Response time (Emergency services); Simulation; Staff Development - methods; Task Performance and Analysis; Teams; Time-to-Treatment - standards; Transportation of Patients - methods; Transportation of Patients - standards; Uterine Rupture - surgery; Uterus; United States; United States > US; emergency cesarean delivery; delays in transport to the OR; quality improvement; uterine rupture; simulated obstetric crises
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2012.98

Objective:
We documented time to key milestones and determined reasons for transport-related delays during simulated emergency cesarean.
Study Design:
Prospective, observational investigation of delivery of care processes by multidisciplinary teams of obstetric providers on the labor and delivery unit at Lucile Packard Children’s Hospital, Stanford, CA, USA, during 14 simulated uterine rupture scenarios. The primary outcome measure was the total time from recognition of the emergency (time zero) to that of surgical incision.
Result:
The median (interquartile range) from time zero until incision was 9 min 27 s (8:55 to 10:27 min:s).
Conclusion:
In this series of emergency cesarean drills, our teams required approximately nine and a half minutes to move from the labor room to the nearby operating room (OR) and make the surgical incision. Multiple barriers to efficient transport were identified. This study demonstrates the utility of simulation to identify and correct institution-specific barriers that delay transport to the OR and initiation of emergency cesarean delivery.