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A multidisciplinary team consensus on the allocation of resources, roles and responsibilities at emergency crash cesarean deliveries
Abstract Number: F-16
Abstract Type: Original Research
Emergency crash cesarean deliveries are usually performed in a sporadic manner and are often chaotic moments on the Labor and Delivery floor (1). The necessary tasks are completed in a haphazard manner that risks patient safety and is often stressful for the health care professionals involved(2-4). The aims of this study are: 1) to identify the current barriers that limit the ability of the multidisciplinary team to perform emergency crash cesarean deliveries in an organized, co-ordinated and timely manner; 2) to generate a protocol to perform these tasks in an organized fashion.
This is an ongoing study where a modified Delphi technique(5)is being used as a consensus building tool to obtain the opinions of an expert panel of anesthesiologists, obstetricians, obstetric nurses, respiratory therapists/anesthesia assistants and neonatologists. The study is being conducted in four rounds. An open-ended questionnaire was sent out in Round 1 to gather opinions on the current challenges in performing an emergency crash cesarean delivery and the possible suggested solutions. The level of agreement with the opinions stated in Round 1 was then sought in Round 2. Ideas that reached an agreement >70% were considered to have achieved consensus. These ideas will be used in Round 3 to build a list of resources, roles and tasks required for an emergency crash cesarean delivery, based on a face-to-face multidisciplinary discussion with 1-2 representative (s) of each stakeholder. We will then build a practical guideline/algorithm that details resource and task allocations as well as communication. Agreement on such document will be sought in Round 4.
We invited 35 subjects representing the five stakeholder groups; 25 consented to the study. In Round 1, communication across the multi-disciplinary teams and human resource allocation were the main themes of the current challenges experienced by the team. In Round 2, there was consensus within the stakeholders about the following 1) need for an agreed definition of emergency crash cesarean delivery; 2) need for an agreed criteria for urgency; 3) need to improve handover of patient information across the specialities; 4) need to improve assistance available to anesthetists to provide general anesthesia; 5) need to improve the inefficiency of the process due to inadequate number of nurses to carry out tasks; 6) need to define a leader for the emergency situation.
Major deficiencies in our current system have been identified. The results of this study will provide a tool for education of the multidisciplinary team involved in emergency crash cesarean deliveries.
1) J Obstet Gynaecol Can 2015;37:1116–7;
2) J Obstet Gynaecol Can 2013;35:82–83;
3) Acta Anaesthesiol Scand 2015;59:1287–95;
4) Curr Opin Anesthesiol 2009;22:352 – 356;
5) Can J Anesth 2015;62:271-7