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The Effects of an Obstetric Emergency Cesarean Checklist on Decision-to Incision Time in a Rural Hospital Setting: Quality Improvement Project

Jesse Berndt, RN, DNP, CRNA

DNP Nurse Anesthesia

The Effects of an Obstetric Emergency Cesarean Checklist on Decision-to-Incision Time in a Rural Hospital Setting: Quality Improvement Project

Project Category:  EBP

Project Team: Jesse Berndt, DNP, CRNA Shontanay Anders, DNP, CRNA Jennifer Greenwood, CRNA, PhD, Kristine Tierney, CRNA, DNP (Advisor)


Background: Postpartum hemorrhage is an avoidable complication of childbirth, with an increased risk of maternal morbidity and mortality, especially with cesarean sections. Through the utilization of cognitive aids, this quality improvement (QI) project aimed to reduce decision-to-incision times, promote multidisciplinary communication, and improve provider confidence levels during obstetric emergencies.

Methods: This project involved a QI design at a 49-bed rural tertiary medical center, where operating room (OR) and obstetrical (OB) units received education and checklists to guide emergency OB management. A reliable survey from the National Council of State Boards of Nursing’s (NCSBN) report on the effects of high-fidelity simulation was adapted for this project to evaluate nurses' self-confidence in managing OB emergencies. Staff members completed pre- and post-intervention surveys, and IBM® SPSS® statistics were used to compare confidence scores.

Results: Thirty of 60 (50%) participants responded to the pre-intervention survey, and 28 of 60 (46%) participants responded to the post-intervention survey. The pre-intervention cumulative average confidence score was 4.11 (SD=0.65), and the post-intervention average confidence score was 4.28 (SD=0.59). The overall cumulative confidence scores averaged 4.19 (SD = 0.63); however, statistical significance was not achieved (p= 0.396). The mean decision-to-incision interval was 24.7 minutes (SD=10.2) A P-value of 0.004 demonstrated a statistically significant improvement in communication after implementation of the checklist.

Conclusion: Implementing an OB crisis management checklist in a rural health care facility can increase both provider confidence and interdisciplinary communication during emergencies, while also maintaining a decision-to-incision interval of less than 30 minutes. 

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