Randomized Controlled Simulation Trial to Compare Transfer Procedures for Emergency Cesarean

Abstract Objective To test the hypothesis that capping intravenous and epidural lines would reduce time to transfer women in labor to the operating room and time to readiness for general anesthesia for emergency cesarean. The secondary purpose was to identify latent threats to patient safety. Design Mixed methods analysis of a randomized, controlled, in situ simulation trial. Setting Labor and delivery unit at high-risk referral center. Participants Fifteen interprofessional teams that included labor and delivery nurses and anesthesiology residents. Methods Immediately before simulation, we randomized bedside nurses and anesthesiology residents to one of two groups: usual transfer or the cap and run procedure. Simulation scenarios started with fetal heart rate decelerations that necessitated position changes followed by emergency cesarean. An embedded simulated obstetrician announced the decision for cesarean; completion of an OR checklist confirmed team readiness to induce general anesthesia. Postsimulation debriefing was focused on teamwork and opportunities to improve safety, and we used qualitative analysis to synthesize results. Results We found no statistically significant difference in the overall time from decision for cesarean to readiness for general anesthesia between the two groups (usual transfer median = 445 s [interquartile range, 425–465] vs. cap and run 390 s [interquartile range, 383–443], p = .12). The time in the operating room was less in the cap and run group than in the usual transfer group (median = 300 s vs. 250 s, p = .038). Qualitative analysis of the debriefing data indicated advantages of the capping procedure, including better bed maneuverability and fewer tangled lines. Conclusion We found no evidence of decreased overall time from decision for cesarean to readiness for general anesthesia based on whether the nurse capped the intravenous and epidural lines or pushed the intravenous pole alongside the bed. However, nurses perceived improved patient safety with the cap and run procedure.