///2015 Abstract Details
2015 Abstract Details2019-08-02T16:54:43-06:00

Quality Improvement: A time-motion survey of labor epidural requests

Abstract Number: T-29
Abstract Type: Original Research

Jacqueline E Geier MD1 ; Deborah Stein MD2

Patient satisfaction scores are becoming increasingly more important to hospital administrators due to financial implications. According to private consultants working with our institution, women of child bearing age are the harshest critics on these surveys. In an effort to improve these scores at our institution, multidisciplinary committees have been formed to address a number of the elements of these surveys, particularly in pain management. Given that the majority of survey responders at our institution are obstetric patients, there has been significant pressure to improve pain management scores on the Labor and Delivery as well as postpartum units. We conducted a time motion survey to assess delays in epidural placement and reasons for such delays at the urging of the pain management improvement committee. Over the course of two weeks, 115 patients requested epidural placement for labor analgesia. We had a 37% completion rate of the time-motion survey which included the time each patient was admitted to triage, the time and location of epidural request by the patient, and the times such a request was approved by the obstetrician, the anesthesia team was consulted, and the arrival of the anesthesia team for placement. The survey was attached to each patient’s chart and filled out in real time by the patient’s nurse. Of the completed surveys, 54.8% had an acceptable time to arrival of anesthesiologist from time of request by patient (set at less than 30 minutes). 45.2% of patients experienced a delay (a time greater than 30 minutes from the time of patient request to arrival of anesthesiologist). In the cases of delay, 38% were due to lack of available labor rooms with an average delay of 2 hours, 26% were due to unavailable anesthesiologist with an average delay of 40 minutes, and 26% were delayed due to miscellaneous patient and obstetric reasons. Based on our findings and subsequent report to hospital administration, we were able to justify both a need for increased physical space, increased nursing availability (particularly for patients laboring in our triage area who would like an epidural), as well as the creation of a late-call shift in which an extra senior anesthesiology resident is available between the hours of 5 pm and 11 pm.

SOAP 2015