| Description |
This project was designed to identify and evaluate key challenges a rural hospital has in providing a reliable best practice response, analyze newborn outcomes and disseminate findings to other rural hospitals that might be challenged when confronted with an Emergency Caesarean Section (ECS). Rural hospital settings are fraught with challenges performing ECS's. The American Congress of Obstetrics (ACOG), recommend that obstetrical services should be able to reliably perform an ECS with a decision to incision time (DIT) of 30 minutes or less. Seventy percent of neonatal brain injury may occur during the intrapartum period. The third highest ranked reason for obstetrical law suits surround the timely response, performance, or not performing an indicated ECS. The problem statement identifies that system and organizational barriers challenge rural hospitals' ability to meet DIT times of 30 minutes or less for an ECS. A quality improvement (QI) project, Pit Crew 4 Emergency C-Section (2015), evaluation might give recommendations for this hospital's project continuance, direction and dissemination. Policy and organizational significance reveals the importance that a rural hospital mitigates restraining forces and enhances driving forces that effect a timely response in an adverse obstetrical event. Obstetrical team stakeholder's policies that enact important safeguards to promote good newborn outcomes are worthy implementation goals. By understanding and demonstrating the impact of DIT in ECS, this project may develop stakeholder polices that support meeting ACOG criteria guidelines. The objectives of this project analyzed ECS DIT and newborn outcomes, conducted and analyzed staff questionnaires to quantify the quality improvement process effectiveness, role clarifications, and driving & restraining forces in an ECS, and translate and disseminate findings to stakeholders, rural hospitals, and broadly at a state-wide, regional, or national conferences. The literature review focused on understanding and expanding information about DIT times, rural health care barriers, ECS indications, fetal monitoring, and potential adverse fetal outcomes when there is a delayed response to an ECS. Kurt Lewin's "Change" and "Force Field Analysis" resonates with this project because the tradition and culture in rural facilities have barriers with change. Obstetrical (OB)team stakeholders in rural settings may be far removed from environments where change is both accepted and encouraged. Driving and restraining forces as identified in the Force Field theory are important items to analyze in this setting to initiate a reliable team response to an ECS. Implementation and plan involved a retrospective records review (pre-post) intervention using paired T-Tests for DIT's. The analyzed data included DIT times, 5 minute Apgar, and newborn respiratory distress & hospital transfer. Obstetrical team stakeholders completed a questionnaire that gave overall and group comparisons about role clarifications and attitudes. Clinically significant findings illuminated best practice opportunities in the rural settings. Evening and weekend DIT's demonstrated DIT times exceeded 30 minutes; and questionnaires revealed that the QI project needed to continue. Factors that prohibited providers from meeting DIT in less than 30 minutes included lack of training and skills. Operational constraints included the anesthesia/surgical response time and OB nurses not trained to scrub or circulate as most crucial. Most respondents agreed good newborn outcome as the strongest driving force in ECS. Dr. Gillian Tufts (Director); Dr. Barbara Wilson, (Chair); Jean Millar RN MBA, (Content Expert) |
