A Multidisciplinary Approach to Peripartum Triaging of Patients to the Operating Room: A Quality Improvement Project
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Pregnancy Complications
- Sponsor
- Johns Hopkins University
- Enrollment
- 1380
- Primary Endpoint
- nil per os (NPO) status
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
Investigators propose a four-category triaging system to delineate and facilitate the communication and action plan for all types of obstetric OR cases via a multidisciplinary approach. Investigators omitted ambiguous terms and developed an algorithm to categorize patients according to acuity and risk. Investigators' quality improvement intervention allows for rapidly changing circumstances and accounts for both obstetric and anesthetic considerations.
Several metrics will be collected to evaluate this multidisciplinary quality improvement project, including maternal demographics, labor characteristics, and indication for surgical intervention. Additional data include level assigned, time of patient arrival in OR, type of surgery performed, and anesthetic delivered. Investigators will collect fetal delivery data, including Apgar scores and umbilical cord gases, as well as maternal delivery data, including estimated blood loss, time to uterine incision and delivery, and surgical complications.
Detailed Description
At investigators' institution, a triage (or leveling) system for emergency surgeries in the general operating rooms (OR) exists with the goal of optimizing patient care and reducing morbidity and mortality. In the obstetric field, while medical terminology exists for these situations to delineate and convey the urgency of a particular peripartum situation, for example "stat, emergent, or urgent," it is generally acknowledged that this terminology is not universal and is somewhat ambiguous, causing confusion and unnecessary delays in patient care. Investigators propose a quality improvement project which will delineate terminology for obstetrical triaging to the OR and discuss metrics for evaluation of this quality improvement intervention. Investigators developed a multidisciplinary stratification system at investigators' institution to triage obstetric patients into a four-level system with clear guidelines for all OR cases. Investigators' categorization system accounted for maternal and fetal stability, indication for surgical intervention, role for obtaining additional studies, nil per os (NPO) status, and surgical and anesthetic concerns. Within each of the four classifications, investigators defined the expectations for each team member's role, including the obstetrician, anesthesiologist, charge nurse, nursing staff, neonatal intensive care unit (NICU) team, and the surgical and clinical technicians. Several metrics will be collected to evaluate this multidisciplinary quality improvement project, including maternal demographics, labor characteristics, and indication for surgical intervention. Additional data include level assigned, time of patient arrival in OR, type of surgery performed, and anesthetic delivered. Investigators will collect fetal delivery data, including Apgar scores and umbilical cord gases, as well as maternal delivery data, including estimated blood loss, time to uterine incision and delivery, and surgical complications.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Female of child-bearing age, requiring emergent procedure in operating room (including cesarean section, D\&C, cerclage placement or removal)
Exclusion Criteria
- •Patients not requiring urgent surgical or invasive procedures
Outcomes
Primary Outcomes
nil per os (NPO) status
Time Frame: 1 year
Time of last intake (fluid or solids) measured in hours and minutes
Surgical concerns
Time Frame: 1 year
Concerns that may change our care, i.e. patient is full stomach but needs to have urgent surgery. This will be assessed via observation of patient condition and need of hospital care
Materno-fetal stability
Time Frame: 1 year
This will be assessed by ICU admissions (days) and total length of hospital stay (days)
Indication for surgical intervention
Time Frame: 1 year
surgery is required if patient has one or more of the following reasons: non-reassuring fetal tracing, umbilical cord prolapse, peripartum hemorrhage, or emergency dilation and curettage.
Role for obtaining additional studies
Time Frame: 1 year
determine by the number of additional testing including Labs, imaging or EKG a patient required on top of standard studies.