542: Impact of a new obstetric communication system (OCS) on decision to delivery times

Abstract

In obstetric emergencies, care coordination is critical in achieving a “decision-to-delivery” time of 30 minutes. Reliable communication is essential to optimize coordinated care of mother and baby: poor communication produces barriers that are magnified in any emergency. We lacked a synchronous communication strategy for emergency notification at our institution, and believed our decision-to-delivery times were not ideal. We sought to determine the impact of a new OCS on decision to delivery time. A multidisciplinary team developed a clinical mobility platform that uses a wall-mounted panel paired with mobile technology to alert all relevant clinical staff. This new platform uses in-room pre-programmed pads that alert predetermined responders matching the emergency. For example, the “STAT section” button summons doctors(OB, Anesthesia, and neonatology), OB nurses and NICU staff via dedicated phones. Impact of this platform was assessed with process and outcome data: decision for C-section to time of: skin incision, uterine incision, and delivery; cord artery pH, and 5-minute Apgar score. This pre and post implementation study (April-September 2018 vs January-June 2019) centered on the opening of our new Obstetric Care Unit. Data were analyzed with Chi-square and Mann Whitney U. Urgent/emergent cesarean delivery was done in 93 women pre- and 68 post-implementation of the new OCS. Post-implementation, women had a 10-minute reduction in time from decision to delivery (30 minutes pre- vs 20 minutes post-implementation, p = 0.027). Delivery within 30 minutes improved by 18.6% (p = 0.018). Times to skin and uterine incision were also significantly reduced. The two groups had similar neonatal outcomes: birthweight, 5 minute Apgar, and cord artery pH did not differ, but the study was underpowered to compare these outcomes. (Table) This new OCS reduced decision-to-delivery time by 33%, in turn improving compliance with the “30-minute rule”. All relevant personnel were contacted specifically, while avoiding overhead paging and other incomplete or confusing messages.