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Improving STAT Cesarean Performance Through Industrial Engineering
Abstract Number: T-32
Abstract Type: Original Research
The risk of emergency cesarean delivery is present during labor. Several critical steps are necessary in order to carry out emergent delivery without error, miscommunication, and delay. Not surprisingly, the complication rate in emergency cases is much higher than elective cases.1 It seems unlikely that the classic controlled trial would affect a significant improvement in a complex process. Plan-Do-Check-Act methodology (PDCA) is an industrial engineering tool that identifies and corrects complex processes in a systematic way.2 We hypothesized that PDCA methodology alongside STAT Cesarean simulation could be utilized to reduce error and create efficiencies in care.
Between 2/2011 and 1/2014, we conducted in situ STAT cesarean simulations every 4-6 weeks. We used the PDCA model to 1) define the process components, 2) identify errors and variations of practice, 3) develop and train standardized practices (Fig.). Simulations were audited by observers and intermittently filmed. Staff involved in the simulation debriefed to obtain process improvement input. Changes were planned after sessions in an iterative fashion, and staff education was performed prior to the next session.
Several process categories were identified: Transport, Communication, Safety, OR Setup, Patient preparation. A total of 37 major process changes have been standardized to date, with significantly fewer in the later sessions (P<0.05). Initial process changes focused on transport, communication and staff roles, as it was found that providers generally focused on their individual role rather than on the coordination of the team. Later changes focused on introducing safety and team coordination. Several process changes required multiple iterations to perfect. Safety changes that were incorporated included timing of surgical item counts, skin prep, airway equipment, timeout scripting, and DVT prophylaxis. There was also a decrease in time to skin incision and instrument count on the videos, but the sample size is not yet adequate.
We were able to use PDCA methodology to standardize coordinated team practice for STAT cesarean delivery. By using iterative testing and evaluating changes we were able to develop standardized processes for stat cesarean, improve efficiencies and enhance patient safety features. It seems unlikely that a controlled experiment could accomplish these changes.
Pallasmaa Acta Ob Gyn Scand 2010
Improving Quality Through Planned Experimentation. 1991