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Factors contributing to time from patient entry to operating room (OR) to spinal anesthesia administration for scheduled cesarean delivery in a large academic center
Abstract Number: T1C-245
Abstract Type: Original Research
Ongoing interdisciplinary meetings in our academic center have prompted the evaluation of numerous factors contributing to operating room (OR) inefficiencies. We evaluated the contribution of ‘anesthesia’ to possible delays and examined factors thought to affect the time from patient entry to the OR to spinal anesthesia administration in elective cesarean deliveries (CD).
In this ongoing observational study, data were collected from electronic anesthetic records between June-Dec 2018. Presence of Ob Anesthesia attending for spinal/CSE placement by residents/fellows is guaranteed for all CD. It is standard practice to hit touch-screen buttons when patient enters OR (in OR) and when spinal dose is injected (spinal). Patient demographics, anesthetic technique, resident level of training, attending, were collected. Outcomes were time to spinal (TTS) calculated as time from ‘in OR’ to ‘spinal’ (min) and excess TTS defined as time >75th percentile (18 min).
Analysis included 304 elective CD under spinal (N=259) or CSE (N=45). Median TTS was 14min (IQR 11-18) and excess TTS rate was 22%. Univariate analysis of TTS and excess TTS is presented in Table. In univariate analysis, higher BMI and CSE were associated with both increased TTS and excess TTS. The level of training (by CA-year or months in Ob anesthesia) did not influence TTS, but there were marked variations in TTS and excess TTS among the 10 Ob Anesthesia attendings (from 10 to 16 min for TTS and 9 to 40% for excess TTS) Using mixed-effects models, younger age and CSE predicted excess TTS (Table).
As anticipated, higher BMI and CSE were associated with increased time to spinal dose administration. Contrary to our expectation, residents’ level of training did not impact time to spinal; this is likely due to the fact that attendings are always present and will intervene when junior residents are unsuccessful on 1st attempt. We did not expect the significant variability between attendings, although this had been anecdotally reported by the nurses. This data will allow to evaluate trends and more importantly to reassure all stakeholders that despite the high acuity of our patients and presence of novice trainees, our performance with a median time of 14min from OR entry to spinal dose is actually quite remarkable. Further analysis of the interaction between resident’s level of training and attendings (pairings) will be of interest.