Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

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Abstract

Cesarean delivery is the most common surgery performed in the United States, accounting for approximately 32% of all births. Emergency Cesarean deliveries are performed in the event of critical maternal or fetal distress and require effective collaboration and coordination of care by a multidisciplinary team with a high level of technical expertise. It is not well understood how the physical environment of the operating room (OR) impacts performance and how specialties work together in the space.

Objective

This study aimed to begin to address this gap using validated techniques in human factors to perform a participatory user-centered analysis of physical space during emergency Cesarean.

Methods

This study employed a mixed-methods design. Focus group interviews and surveys were administered to a convenience sample (n = 34) of multidisciplinary obstetric teams. Data collected from focus group interviews were used to perform a task and equipment analysis. Survey data were coded and mapped by specialty to identify reported areas of congestion and time spent, and to identify themes related to physical space of the OR and labor and delivery unit.

Results

Task analysis revealed complex interdependencies between specialties. Thirty task groupings requiring over 20 pieces of equipment were identified. Perceived areas of congestion and areas of time spent in the OR varied by clinical specialty. The following categories emerged as main challenges encountered during an emergency Cesarean: 1) size of physical space and equipment, 2) layout and orientation, and 3) patient transport.

Conclusion

User insights on physical space and workflow processes during emergency Cesarean section at the institution studied revealed challenges related to getting the patients into the OR expediently and having space to perform tasks without crowding or staff injury. By utilizing human factors techniques, other institutions may build upon our findings to improve safety during emergency situations on labor and delivery.

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Most cited references 33

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Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

J. Ye, J. Zhang, R Mikolajczyk … (2015)

Objective Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality. Design Ecological study using longitudinal data. Setting Worldwide country‐level data. Population A total of 159 countries were included in the analyses, representing 98.0% of global live births (2005). Methods Nationally representative caesarean section rates from 2000 to 2012 were compiled. We assessed the relationship between caesarean section rates and mortality outcomes, adjusting for socio‐economic development by means of human development index (HDI) using fractional polynomial regression models. Main outcome measures Maternal mortality ratio and neonatal mortality rate. Results Most countries have experienced increases in caesarean section rate during the study period. In the unadjusted analysis, there was a negative association between caesarean section rates and mortality outcomes for low caesarean section rates, especially among the least developed countries. After adjusting for HDI, this effect was much smaller and was only observed below a caesarean section rate of 5–10%. No important association between the caesarean section rate and maternal and neonatal mortality was observed when the caesarean section rate exceeded 10%. Conclusions Although caesarean section is an effective intervention to save maternal and infant lives, based on the available ecological evidence, caesarean section rates higher than around 10% at the population level are not associated with decreases in maternal and neonatal mortality rates, and thus may not be necessary to achieve the lowest maternal and neonatal mortality. Tweetable abstract The caesarean section rate of around 10% may be the optimal rate to achieve the lowest mortality.

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What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies

Ana Betran, Maria Torloni, Jun Zhang … (2015)

In 1985, WHO stated that there was no justification for caesarean section (CS) rates higher than 10–15 % at population-level. While the CS rates worldwide have continued to increase in an unprecedented manner over the subsequent three decades, concern has been raised about the validity of the 1985 landmark statement. We conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. Four electronic databases were searched for ecologic studies published between 2000 and 2014 that analysed the possible association between CS rates and maternal, neonatal or infant mortality or morbidity. Two reviewers performed study selection, data extraction and quality assessment independently. We identified 11,832 unique citations and eight studies were included in the review. Seven studies correlated CS rates with maternal mortality, five with neonatal mortality, four with infant mortality, two with LBW and one with stillbirths. Except for one, all studies were cross-sectional in design and five were global analyses of national-level CS rates versus mortality outcomes. Although the overall quality of the studies was acceptable; only two studies controlled for socio-economic factors and none controlled for clinical or demographic characteristics of the population. In unadjusted analyses, authors found a strong inverse relationship between CS rates and the mortality outcomes so that maternal, neonatal and infant mortality decrease as CS rates increase up to a certain threshold. In the eight studies included in this review, this threshold was at CS rates between 9 and 16 %. However, in the two studies that adjusted for socio-economic factors, this relationship was either weakened or disappeared after controlling for these confounders. CS rates above the threshold of 9–16 % were not associated with decreases in mortality outcomes regardless of adjustments. Our findings could be interpreted to mean that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level. Electronic supplementary material The online version of this article (doi:10.1186/s12978-015-0043-6) contains supplementary material, which is available to authorized users.

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Births: Final Data for 2015.

Joyce Martin, Brady E Hamilton, Michelle Osterman … (2017)

Objectives-This report presents 2015 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.98 million births that occurred in 2015 are presented. Results-In 2015, 3,978,497 births were registered in the United States, down less than 1% from 2014. The general fertility rate was 62.5 per 1,000 women aged 15-44, a decline of 1% from 2014. The birth rate for teenagers aged 15-19 fell 8% in 2015, to 22.3 per 1,000 females. Birth rates declined for women in their 20s but increased for women in their 30s and early 40s. The total fertility rate (estimated number of births over a woman's lifetime) declined to 1,843.5 births per 1,000 women in 2015. The birth rate for unmarried women declined for the seventh straight year to 43.5 per 1,000. The cesarean delivery rate declined for the third year in a row to 32.0%. The preterm birth rate increased slightly from 2014, to 9.63% in 2015, as did the rate of low birthweight (8.07% in 2015). The twin birth rate declined to 33.5 per 1,000; the triplet and higher-order multiple birth rate was down 9% to 103.6 per 100,000.

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Author and article information

Contributors

Kenji T. Sotto:

ORCID: https://orcid.org/0000-0001-5835-4168

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Laura C. Hedli: Role: Writing – original draftRole: Writing – review & editing

Lillian Sie: Role: Data curationRole: Formal analysisRole: Funding acquisitionRole: Project administrationRole: Writing – review & editing

Kimber Padua: Role: Project administrationRole: Writing – original draftRole: Writing – review & editing

Nicole Yamada: Role: Writing – review & editing

Henry Lee:

ORCID: https://orcid.org/0000-0001-8383-1720

Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing

Louis Halamek: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – review & editing

Kay Daniels: Role: ConceptualizationRole: MethodologyRole: ResourcesRole: Writing – review & editing

Dan Nathan-Roberts:

ORCID: https://orcid.org/0000-0002-4428-1823

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draft

Naola S. Austin: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

David Desseauve: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 10 June 2021

Publication date Collection: 2021

Volume: 16

Issue: 6

Electronic Location Identifier: e0252888

Affiliations

[1 ] San José State University, San Jose, California, United States of America

[2 ] The Safety Learning Laboratory for Neonatal and Maternal Care, Stanford University, Stanford, California, United States of America

[3 ] Department of Pediatrics, Stanford University, Stanford, California, United States of America

[4 ] Department of Obstetrics and Gynecology, Stanford University, Stanford, California, United States of America

[5 ] Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, United States of America

Lausanne University Hospital: Centre Hospitalier Universitaire Vaudois (CH), SWITZERLAND

Author notes

Competing Interests: No authors have competing interests.

‡ These authors also contributed equally to this work.

* E-mail: kenji.sotto@ 123456sjsu.edu (KTS); dan.nathan-roberts@ 123456sjsu.edu (DNR)

Author information

Kenji T. Sotto https://orcid.org/0000-0001-5835-4168

Henry Lee https://orcid.org/0000-0001-8383-1720

Dan Nathan-Roberts https://orcid.org/0000-0002-4428-1823

Article

Publisher ID: PONE-D-20-39269

DOI: 10.1371/journal.pone.0252888

PMC ID: 8191948

SO-VID: b05581f6-f83b-4063-b0ff-c9a6ca07e23a

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 14 December 2020

Date accepted : 25 May 2021

Page count

Figures: 5, Tables: 1, Pages: 12

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100000133, Agency for Healthcare Research and Quality;

Award ID: P30HS023506

Award Recipient :

ORCID: https://orcid.org/0000-0001-8383-1720

Henry Lee

This work was undertaken as part of the research portfolio of The Safety Learning Laboratory for Neonatal and Maternal Care at Stanford. HL and LH Grant/award number 'P30HS023506' Agency for Healthcare Research and Quality https://www.ahrq.gov NO.

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Data Availability All relevant data are within the manuscript and its Supporting Information files.

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

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Most cited references 33

Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population‐based ecological study with longitudinal data

What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies

Births: Final Data for 2015.

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