Emergency cesarean deliveries occur every day in the United States. These high-risk surgical procedures require a unified multidisciplinary response to optimize maternal-fetal outcomes. Nationally the recommended guideline for an emergency cesarean delivery is 30 minutes from decision to incision. Often times, 30 minutes is too long.   Our high risk tertiary center determined that there needed to be a marked improvement in moving obstetrical patients from labor and delivery to the operating room. In turn this would improve timeliness in expediting an emergency delivery leading to a successful maternal-fetal outcome.

Proposed change:

Effective responses to an emergency cesarean delivery requires a multidisciplinary approach.  We created a multidisciplinary committee that included  Perinatal Nurses as well as physicians from the Departments of OB-GYN and Anesthesia.  Standardization of our ability to respond to emergency cesarean delivery was the central theme of our process improvement.   

Implementation, outcomes and evaluation:

A multidisciplinary policy was developed that reflected the roles and responsibilities of those personnel involved with a “Code 77”. The staff were educated through emails, staff meetings and bulletin boards. After a “Code 77” has occurred, a debriefing form  is completed by the Charge Nurse and the Attending Obstetrician. Problems and areas for improvement are identified.  The turn around time for improvements is 24- 48 hours.  A key component of our success was the development of a group page that enabled us to page our entire team with one phone call. The team includes three  obstetricians, two  anesthesiologists, a neonatal resuscitation team, Labor and Delivery staff, and key nursing leadership. Periodically, Code 77 drills are conducted to ensure that all steps of the policy are followed and system errors are identified. From the time an emergency is identified until the patient leaves the labor room averages less than 60 seconds. The average time from decision to incision has decreased from twelve minutes to seven minutes specifically in those cases where fetal bradycardia occurred and the patient required general anesthesia.

Implications for nursing practice:

Standardization of emergency cesarean delivery processes can save valuable time in an emergency. The establishment of a process improvement program will help in the identification of processes that need to be revised or updated. By having a multidisciplinary team, the ideas and tasks that need to be accomplished are at the forefront of providing quality care to ensure an optimal maternal-fetal outcome.   

Keywords: emergency cesarean, multidisciplinary team, quality improvement