A multidisciplinary approach to improving process and outcomes in unscheduled cesarean deliveries

• Published in: American journal of obstetrics & gynecology MFM 2020-02, Vol.2 (1), p.100070-100070, Article 100070
• Main Authors: Quant, Hayley S., Hamm, Rebecca F., Schwartz, Nadav, Srinivas, Sindhu K.
• Format: Article
• Language: English
• Subjects: 30-minute rule; decision to incision interval; obstetric team training; patient safety; process improvement; quality improvement
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2019.100070

Effective communication between providers of various disciplines is crucial to the quality of care provided on labor and delivery. The lack of standardized language for communicating the clinical urgency of cesarean delivery and the lack of standardized processes for responding were identified as targets for improvement by the Obstetric Patient Safety Committee at the Hospital of the University of Pennsylvania. The committee developed and implemented a protocol aimed at improving the performance of our multidisciplinary team and patient outcomes. To evaluate whether implementation of a multidisciplinary protocol that standardizes the language and process for performing unscheduled cesarean deliveries had reduced the decision to incision interval and improved maternal and neonatal outcomes. This was a retrospective cohort study of patients who underwent unscheduled cesarean delivery pre- and postimplementation of a protocol standardizing language, communication, provider roles, and processes. The primary outcome was cesarean decision to incision interval overall and stratified by fetal and nonfetal indications for delivery. Secondary outcomes included decision to operating room and operating room to incision intervals, operative complications, use of general anesthesia, maternal transfusion, 5-minute Apgar score