iversity of Cincinnati Medical Center (UCMC) is a 550-bed academic level 4 maternal care center with a 13-bed L&D unit in Cincinnati, OH. There are approximately 2500 deliveries/y with a CD rate of 33%. The L&D unit is staffed with dedicated anesthesia personnel 24 hours a day. In our L&D unit, there was widespread dissatisfaction with multidisciplinary communication surrounding unscheduled CD. Near-miss safety events in our obstetric unit were attributed to preoperative communication failures. Initial surveys identified challenges in preoperative communication among nursing, anesthesiology, and obstetric teams leading to potential risk for compromised care. METHOD: Using the UC Health Performance Improvement Way, we first sought to understand the process leading up to unscheduled CD. Change ideas were developed based on observed failures in communication. Interventions were tested and refined through iterative plan-do-study-act (PDSA) cycles. One key intervention was the introduction of a bedside, multidisciplinary, patient-centered, pre-CD huddle attended by nursing, anesthesia, and obstetrics representatives using a standard checklist for critical information. Qualitative patient feedback was elicited to inform change efforts. We compared patient and procedure characteristics from the baseline and huddle implementation phases. MEASURES: Our primary outcome measure was the satisfaction of care team members with communication around unscheduled CD. A secondary outcome was the general anesthesia (GA) rate for unscheduled CD. Our key process measure was adherence to the preoperative huddle. We tracked decision-to-incision interval (DTI) as a balancing measure. RESULTS: Huddle adherence reached 96% for unscheduled CD within 6 months of testing and implementation. A combined survey of anesthesia, nursing, and obstetrics showed that satisfaction scores related to unscheduled CD communication improved from 3.3/5 to 4.7/5 after huddle implementation. The rate of GA use and the median DTI remained unchanged. Patients felt more engaged and reported positive experiences by being a part of the huddle discussion. CONCLUSIONS: In an academic obstetric unit, communication failures surrounding unscheduled CD were identified as a contributor to staff dissatisfaction and perception of safety risk. Implementation of a bedside multidisciplinary pre-CD huddle improved communication between teams and contributed to creating a culture of safety without causing significant delays in care....

中文翻译：

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术前多学科团队抱团改善计划外剖宫产的沟通和安全性：使用改进科学重新设计系统


辛辛那提医学中心（UCMC）是一个拥有550个床位的学术级4级孕产妇护理中心，拥有13个床位的L&D单位。每年大约有 2500 次交货，CD 率为 33%。L&D单位配备了全天候24小时的专职麻醉人员。在我们的学习与发展部门，对围绕计划外CD的多学科沟通普遍不满。我们产科的未遂安全事件归因于术前沟通失败。初步调查确定了护理、麻醉学和产科团队之间术前沟通的挑战，导致护理受损的潜在风险。方法： 使用 UC 健康绩效改进方法，我们首先试图了解导致计划外 CD 的过程。变革想法是根据观察到的沟通失败而制定的。通过迭代计划-执行-研究-行为 （PDSA） 周期测试和改进干预措施。一项关键的干预措施是引入床边、多学科、以患者为中心、CD 前会议，由护理、麻醉和产科代表使用关键信息的标准清单参加。引出定性的患者反馈，为变革工作提供信息。我们比较了基线和 Huddle 实施阶段的患者和手术特征。措施： 我们的主要结局指标是护理团队成员对围绕计划外 CD 进行沟通的满意度。次要结局是计划外 CD 的全身麻醉 （GA） 率。我们的关键过程衡量标准是遵守术前抱团。我们跟踪决策到切口间隔 （DTI） 作为平衡措施。结果： 在测试和实施后的 6 个月内，计划外 CD 的 Huddle 依从性达到 96%。 麻醉、护理和产科的综合调查显示，实施抱团后，与计划外 CD 通信相关的满意度得分从 3.3/5 提高到 4.7/5。GA 使用率和 DTI 中位数保持不变。通过参与抱团讨论，患者感觉更加投入并报告了积极的体验。结论： 在一个学术产科病房中，围绕计划外 CD 的沟通失败被确定为导致员工不满和安全风险感知的一个因素。实施床边多学科 CD 前抱团改善了团队之间的沟通，并有助于创造一种安全文化，而不会造成严重的护理延误。