Randomized Controlled Simulation Trial to Compare Transfer Procedures for Emergency Cesarean

Area of Science:

• Obstetrics and Gynecology
• Patient Safety
• Anesthesiology

Background:

• Emergency cesarean delivery requires rapid team response.
• Optimizing patient transfer and anesthesia preparation is critical for maternal outcomes.
• Current transfer protocols may present challenges to efficient team mobilization.

Purpose of the Study:

• To evaluate if capping intravenous (IV) and epidural lines reduces transfer time to the operating room (OR).
• To assess the impact of line capping on time to readiness for general anesthesia during emergency cesarean.
• To identify potential patient safety threats within the emergency cesarean workflow.

Main Methods:

• A randomized, controlled, in-situ simulation trial was conducted on the labor and delivery unit.
• Fifteen interprofessional teams (nurses, anesthesiology residents) participated.
• Teams were randomized to either usual transfer or the "cap and run" procedure before simulation scenarios.

Main Results:

• No statistically significant difference in time from decision to cesarean to anesthesia readiness between groups (p=.12).
• The "cap and run" group showed a statistically significant reduction in time spent in the operating room (p=.038).
• Qualitative analysis revealed benefits of "cap and run," including improved bed maneuverability and fewer tangled lines.

Conclusions:

• Capping IV and epidural lines did not decrease overall time to anesthesia readiness for emergency cesarean.
• The "cap and run" procedure demonstrated potential benefits in OR transfer efficiency and perceived patient safety by nursing staff.