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OB operating rooms are closing for renovations. What do we do?
Abstract Number: S-42
Abstract Type: Other
When renovations require an L&D suite to close the ORs, the transportation of parturients to the main OR for emergency cesarean presents a challenge. The L&D ORs at our hospital were scheduled to temporarily close, requiring a plan to allow construction while maximizing safety. Healthcare Failure Mode and Effect Analysis (HFMEA) 1, a method allowing for hazardous failures to be identified so that solutions can be developed, was utilized. A risk assessment was undertaken to identify and prioritize risks associated with transportation of high-risk parturients from L&D to the main OR (a distance of approximately two city blocks).
1. To conduct an HFMEA and determine if risks could be identified and reduced
2. To assess the results of the HFMEA
3. To evaluate the success of proposed interventions to reduce patient risk
Components of the HFMEA included observations during all time frames (including nights & weekends). Results were discussed and validated by a multi-disciplinary team including anesthesiologists, obstetricians, nurses, neonatologists, and hospital administrators. The HFMEA team explored potential risks and suggested interventions that could be put in place during the transition. Alternative strategies were discussed and consensus reached regarding which processes would be implemented.
I. The following issues were identified by HFMEA and corresponding solutions advocated by the multi-disciplinary team:
1. Time to transportation to OR could be excessive.
a. Practice runs to reduce time.
b. Reserved elevators
c. Three main OR operating rooms ready at all times for OB cases
d. Additional staffing requirements for coverage in two locations simultaneously.
2. Identification of communication issues between main OR and L&D
a. Joint simulated drills
b. Improved phone/walkie-talkie system
c. Protocols for transport of postoperative patients back to L&D recovery
3. Plans for delivery of patients too unstable to be transported to the main OR
a. Policies to determine who should not be transported to the main OR
b. Transformation of an L&D room to a nemergency OR on the L&D floor.
II. Utilization of Emergency OR on L&D
OR renovations began on October 1, 2013. With 1250 deliveries since then, the emergency OR has thus far been used 19 times (12 deliveries for fetal bradycardia, 5 for placental abruption, 1 maternal hemorrhage, and 1 uterine rupture)
We proactively assessed risks and incorporated solutions using a modified HFMEA process. This allowed recommendations to be made, trialed, and implemented prior to actual closure of the L&D ORs. With our renovations almost complete, we have shown the following:
1. HFMEA was successfully used to identify risks and implement solutions
2. L&D ORs were temporarily closed while maintaining safety
3. Labor room conversion to a makeshift OR can reduce risk and potentially be life-saving.
1. DeRosier J, et al. Jt Comm J Qual. 2002;28:248-67.