249: Quality improvement initiative to reduce time from regional anesthesia placement-to-delivery for cesarean delivery

Abstract

Longer time from placement of regional anesthesia to cesarean delivery increases the exposure of the fetus to the risk of hypotension. Our objective was to evaluate the impact of a quality improvement (QI) initiative on the regional anesthesia-to-delivery time for cesarean delivery (CD). We performed a quality improvement trial. Before June 18th, 2018, the preoperative protocol was as follows: the Anesthesiologist administered regional anesthesia in the operating room then the nurse placed the Foley catheter, clipped pubic hair, pre-cleaned the abdomen and finally performed sterile Chlorhexidine abdominal preparation. On June 18th, 2018, the protocol changed and all the pre-operative preparation (Foley, clip and pre-clean) were performed prior to the arrival in the operating room. The records of patients who underwent scheduled or non- emergency CD between May 1, and July 15, 2018 were reviewed. Our primary outcome was the time between regional anesthesia placement to delivery of the fetus. Our secondary outcomes included anesthesia-to-abdominal preparation, anesthesia–to-skin incision, and anesthesia-to-skin closure times. Assuming a regional anesthesia-to- delivery time of 30 +/- 5 minutes in the control group, and a decrease of 10% with the new protocol, with alpha of 0.05 and 90% power, at least 58 patients were needed in each period. Bivariate and multivariable analyses were performed (significance: p < 0.05). One hundred and ninety-four patients were included, 124 before and 70 after the process change. There were no differences in the baseline characteristics (Table 1). The change lead to a significant reduction in anesthesia-to- delivery time, even after adjusting for number of prior CD and BMI. Other times were also significantly impacted by the change (Table 2). Our QI initiative significantly decreased the time from anesthesia placement to delivery of the fetus. Additional studies are needed to determine whether this is associated with improvement in perinatal outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)