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Randomized Controlled Simulation Trial Comparing Procedures to Transfer Patients to the Operating Room for Emergency Cesarean Delivery
Abstract Number: F-06
Abstract Type: Original Research
BACKGROUND: To reduce the risk of line entanglement, medication error and IV dislodgment during transfer to the OR for emergency cesarean delivery, the SOAP Patient Safety Committee has proposed a new procedure to cap all intravenous and epidural lines and to separate the infusion pump from the patient during transport.1
METHODS: This in situ simulation study randomized 14 clinical teams to transfer a live patient actor to the operating room utilizing this new “cap and run” procedure or usual transfer procedures. We hypothesized that capping all lines, placing the main IV in the bed next to the patient, and pushing the IV pole separated from the bed would reduce total time to both transfer to the OR, and to prepare for emergency general anesthesia. Immediately prior to the simulation, each bedside nurse randomized to the “cap and run” procedure was introduced to the procedure and allowed to practice briefly. All others remained naïve to the change in procedure. The scenarios started with in utero resuscitation of recurrent FHR decelerations that necessitated position changes and led to line entanglement. The primary outcome measure was the time from decision in the labor room until the anesthesia resident had completed all necessary tasks to prepare for induction of general anesthesia.2 Secondary outcomes included intermediate times and qualitative observations.
RESULTS: 12 simulations have been completed, 8 canceled due to unit workload or staff availability, and at least 2 more scheduled. The following best practices appeared to improve efficiency during transport and preparation for general anesthesia: 1) raise the labor bed prior to disconnecting the power cord, 2) disconnect all labor room monitors prior to transfer, and 3) standardize the location of equipment (e.g., drape clips in the OR). In the most efficient teams, nurses were skilled in managing the steer function on the labor bed and applying the arm board in the OR. For the anesthesiologist, airway examination, bicitra administration, and application of the facemask should be completed first, followed by connecting and cycling the blood pressure cuff. The sequence of other activities did not appear to change preparation times.
CONCLUSIONS: Quantitative analysis was deferred until all simulations have been completed, likely in the next week. Qualitative analysis has identified a number of practice changes to optimize efficiency during transfer for emergency cesarean delivery and preparation for general anesthesia.
1. Kacmar R, APSF Newsletter 2015;30(2):23-43.
2. Scavone BM, Anesthesiology 2006;105(2):260-6.