GO NOW! An Innovative Emergency Cesarean Response with Exceptional Results
Audio File
- Describe steps taken in improving emergency cesarean response using LEAN methodology.
- Share strategies, such as role definition and physical room layout, implemented for responding to emergency cesarean births.
- Analyze matrix of data collected over a three year period to measure improved emergency cesarean response.
Proposed change: We proposed that we would standardize our nursing response time to the need for an emergency cesarean by defining categories for cesareans, improving our labor rooms and cesarean suite, reducing our steps, streamlining our documentation, developing a call notification tree, and assigning roles when the cesarean was called by the physician.
Implementation, outcomes and evaluation: Following three LEAN events, we identified and defined three categories for cesarean birth. We then defined the role of each staff member when a decision was made to proceed with an emergency cesarean. We improved the physical environment of our unit by standardizing the set-up of our cesarean suite to that of the main surgical suites in our surgery department. We also improved on the set-up of our birthing rooms to reduce the number of steps staff needed to take in preparation for an emergency case. We developed checklists and a call tree to further standardize our work. Prior to implementation we held a skills lab to educate staff on the improved process and provided an opportunity for role-play. We determined quality matrix indicators which have been measured over a period of 3 years. Over this time we continued to fine-tune our process and identified areas for further improvement. We have improved the time for decision to operating room (OR) from a mean of 12 minutes to a mean of 2 minutes. We have also significantly reduced the variability of nursing response time once a cesarean is called. We have been successful in sustaining the improved response time by continuing to monitor and track our emergency cases and sharing our results with staff.
Implications for nursing practice: Emergency cesarean birth is a high risk procedure that is commonly performed on many hospital-based birthing units. Analyzing and standardizing processes can save precious time in expediting a safe delivery in an emergency situation. Continually monitoring, evaluating and updating improvements results in sustainied outcomes. We believe our process and results could be replicated and would like the opportunity to share our success with others.
Keywords: emergency cesarean, standardization
