Just in Time: Improving Scheduled

Cesarean Start Times

Paper Presentation

Delivery of e⁄cient, quality patient care has

been the ultimate goal of health care profes-

sionals for quite some time. If care delivery is not at

a level that meets or exceeds expectations, patients

and care providers are frustrated. Instead of consid-

ering failed processes, stakeholders tend to blame

each other for de¢ciencies. Research shows that

forums such as interdisciplinary committees may al-

low physicians and nurses to learn more about

each other’s work£ow processes and perspectives,

which provides a solid foundation on which to base

change (Migueles & Brustowicz, 1997). If processes

improve by collaboration among involved parties,

outcomes may also be improved in a manner that

could not be achieved by nurses or physicians

working alone.

In 2008, obstetric team members at Johnson City

Medical Center observed that signi¢cant delays in

Cesarean delivery start times were an issue that

needed to be addressed. Working within our peri-

natal interdisciplinary committee, we began to

reform the way we presented care to our clients

who required scheduled Cesarean deliveries. Be-

ginning with process mapping, barriers to on-time

start of scheduled Cesarean deliveries were identi-

¢ed. Data were gathered by observation and

interviewing crucial stakeholders, and numerous

barriers were uncovered. The overall process as it

currently existed and the identi¢ed barriers were

presented to the committee, whose members be-

gan to deliberate possible solutions. Tools were

created to assist nurses and physicians to insure

all preoperative information was obtained prior to

the patient’s scheduled operative date. Processes

were changed to encourage patients to complete

necessary preoperative forms, have preoperative

lab work, and complete preoperative education in

advance, promoting a more relaxed environment

for the patient on the day of the scheduled birth. An-

esthesia and obstetric care providers changed

practice patterns to attend unit huddles to increase

communication. All providers agreed to present to

the obstetric (OB) unit at least 30 minutes prior to

the expected procedure start time.

As a result of our process improvements, scheduled

Cesarean birth start times have improved by as

much as 40%. By improving the consistency of

scheduled start times, we have enhanced the ex-

perience for all stakeholders. An increased

understanding was noted between nurses and phy-

sicians regarding perceived barriers, opening lines

of communication for future issues. Obstetricians,

anesthesia personnel, and nursing team members

are satis¢ed with improved patient £ow. Our pa-

tients have expressed increased satisfaction due to

decreased wait times. This successful process

change, facilitated by our perinatal interdisciplinary

team, has strengthened our resolve to consistently

strive for high-quality, cost-e¡ective patient care.

Due to the complexity of patient needs, health care

providers everywhere are being forced to develop

their capacity to think together to develop collabo-

rative thought and coordinated action (Grange,

2007). We demonstrate how process mapping, in-

corporated by a collaborative team, can illustrate

stakeholder interests and is a tool that can be

adapted by any focus group.

REFERENCESGrange, G. (2007). The e¡ectiveness of interdisciplinary team dynamics

on treatments in a behavioral health environment. (Unpublished

doctoral dissertation, University of Phoenix). Retrieved http://dis

sertation.com/browse.php?criteria=Author&search=true&key

word=grange%2C+gilton&submit.x=18&submit.y=13

Migueles, E., & Brustowicz, R. (1997). Interdisciplinary quality improvement

in the perioperative program. Nursing Clinics of North America,

32, 215-230.

Marsha Rodgers, RN, BSN,

Center for Women’s Health,

Johnson City Medical Center,

Johnson City, TN

Liane L. Jennings, RNC, BSN,

Center for Women’s Health,

Johnson City Medical Center,

Johnson City, TN

Myra D. Hale, RNC, Center

for Women’s Health, Johnson

City Medical Center, Johnson

City, TN

ProfessionalIssues

S12 JOGNN, 39, S6-S15; 2010. DOI: 10.1111/j.1552-6909.2010.01117.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2010 AWHONN Annual Convention