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

Journal of Perinatology volume 33, pages 259–263 (2013)Cite this article

Subjects

Abstract

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.

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Acknowledgements

We would like to thank Andrea Puck, RN, Nurse Education Specialist, Lucile Packard Children’s Hospital, for creating the OB Stat Nursing Roles cognitive aid included in the Supplementary Appendix, the leadership of Anne Marie Oakeson, Nurse Manager of the labor and delivery unit, Lucile Packard Children’s Hospital and the vision of Risk Management (The Alliance Group) at Stanford and Lucile Packard Children’s Hospital. No financial or other compensation was provided to any of the individuals or groups listed. No funding was received by any of the authors for this study.

Author information

Authors and Affiliations

  1. Division of Obstetric Anesthesia, Department of Anesthesiology, Stanford University School of Medicine, Lucile Packard Children’s Hospital, Stanford, CA, USA

    S S Lipman, B Carvalho & S E Cohen

  2. Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA

    M L Druzin & K Daniels

Authors
  1. S S Lipman
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  2. B Carvalho
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  3. S E Cohen
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  4. M L Druzin
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  5. K Daniels
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Corresponding author

Correspondence to S S Lipman.

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The authors declare no conflict of interest.

Additional information

Portions of this data were presented at the annual meetings of the Society for Obstetric Anesthesia and Perinatology (May 2009, Washington, DC) and the American Society of Anesthesiologists (October 2009, New Orleans, L.A).

Simulated in situ drills identified and led to remediation of institution-specific delays in initiating emergency cesarean delivery.

Supplementary Information accompanies the paper on the Journal of Perinatology website

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Lipman, S., Carvalho, B., Cohen, S. et al. Response times for emergency cesarean delivery: use of simulation drills to assess and improve obstetric team performance. J Perinatol 33, 259–263 (2013). https://doi.org/10.1038/jp.2012.98

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  • DOI: https://doi.org/10.1038/jp.2012.98

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