Use of checklists and educational interventions may improve preparedness for emergency cesarean sections: Study

The cesarean section (CS) is the most frequently performed obstetric surgery globally. Emergency CS procedures have higher rates of illness and death compared to planned elective CS procedures. The World Health Organization's Safe Surgery Checklist has substantially decreased mortality and underlines the importance of cognitive tools, such as checklists, for evaluating healthcare providers and training residents during emergency situations. Recent research paper focuses on the assessment of preparedness for emergency cesarean sections (CS) using a checklist and an educational intervention as a quality improvement study. The study was conducted in an emergency operating room complex in a hospital in India. The research aimed to assess the preparedness for emergency CS by utilizing a checklist and educational intervention. Approval from the institutional ethics committee was obtained in May 2020.

Methods and Results

The study began with baseline data collection where 65 emergency CS cases were assessed using a 22-action checklist. The mean percentage of completed actions in the baseline period was found to be 78.80%. Following this, educational intervention sessions were conducted for residents of obstetrics and anesthesiology, as well as nursing officers, to emphasize the importance of each step in the checklist. Post-intervention assessment showed an increase in the overall percentage of completed actions to 92.48%. The results indicated that the educational intervention resulted in improved preparedness for emergency CS, as reflected in the positive attitude of the residents towards patient care.

Observations and Deficiencies

The study observed various parameters, including decision-to-delivery time, incidence of intraoperative hypotension, conversion rate from spinal to general anesthesia, and neonatal Apgar scores. The authors also identified deficiencies in their practice through the educational intervention. However, it was noted that the availability of airway adjuncts remained low even after the intervention. The research paper emphasizes the importance of cognitive aids like checklists for the quality improvement of healthcare systems. It also highlights the need for tailored checklists and ongoing improvement cycles. The study did not assess the actual effect of the checklist on patient outcomes and emphasizes that further improvement and multiple improvement cycles would be necessary. Overall, the paper provides valuable insights into the use of checklists and educational interventions for improving the preparedness for emergency cesarean sections and highlights the need for continued quality improvement efforts in healthcare settings.

Key Points

- The study focused on assessing the preparedness for emergency cesarean sections (CS) using a checklist and an educational intervention as a quality improvement study in an emergency operating room complex in a hospital in India.

- Baseline data collection involved assessing 65 emergency CS cases using a 22-action checklist, with the mean percentage of completed actions in the baseline period found to be 78.80%. After educational intervention sessions for residents of obstetrics and anesthesiology, as well as nursing officers, the overall percentage of completed actions increased to 92.48%, indicating improved preparedness for emergency CS.

- Various parameters were observed, including decision-to-delivery time, incidence of intraoperative hypotension, conversion rate from spinal to general anesthesia, and neonatal Apgar scores. Deficiencies in practice were identified through the educational intervention, such as the low availability of airway adjuncts even after the intervention.

- The study emphasizes the importance of cognitive aids like checklists for the quality improvement of healthcare systems and highlights the need for tailored checklists and ongoing improvement cycles. - The research paper did not assess the actual effect of the checklist on patient outcomes and emphasizes that further improvement and multiple improvement cycles would be necessary.

- Overall, the study provides valuable insights into the use of checklists and educational interventions for improving the preparedness for emergency cesarean sections and highlights the need for continued quality improvement efforts in healthcare settings.

Reference -

Sherin S, Kuberan A, Gupta A, Balasubramanian M, Rudingwa P. Assessment of preparedness for emergency cesarean section by utilizing a checklist before and after an educational intervention: A quality improvement study. J Anaesthesiol Clin Pharmacol 2024;40:530-4.