Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools

Li, Yunping; Ciampa, Erin J.; Zucco, Liana; Levy, Nadav; Colella, Meredith; Golen, Toni; Shainker, Scott A.; Lunderberg, J.M.; Ramachandran, Satya Krishna; Hess, Philip E.

doi:10.1213/ane.0000000000005256

Cited by 11 publications

(18 citation statements)

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“…Statewide spread of the virus was observed in early March and coincided with the declaration of SARS-CoV-2 pandemic by the World Health Organization on 11 March, 2020 [1]. As reports of exponential community transmission became apparent, health care organizations, including hospitals and labor and delivery (L&D) units were prompted to evaluate existing workflow patterns and develop innovations to mitigate risk of viral exposure to patients and staff [2]. The layout and dynamics in L&D units are designed to create a shared experience for family members, while maintaining high levels of readiness for acute deterioration requiring operative delivery.…”

Section: Introductionmentioning

confidence: 99%

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Zucco

Levy

et al. 2021

BMC Health Serv Res

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Background Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation of a novel comprehensive checklist for the perioperative care of the COVID-19 parturient. Methods Within our labour and delivery unit, implementation of a novel checklist for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the checklist was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time. Conclusion We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

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Section: Introductionmentioning

confidence: 99%

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Zucco

Levy

et al. 2021

BMC Health Serv Res

Self Cite

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show abstract

“…Statewide spread of the virus was observed in early March and coincided with the declaration of SARS-CoV-2 pandemic by the World Health Organization on 11 March, 2020 (1). As reports of exponential community transmission became apparent, health care organizations, including hospitals and labor and delivery (L&D) units were prompted to evaluate existing work ow patterns and develop innovations to mitigate risk of viral exposure to patients and staff (2). The layout and dynamics in L&D units are designed to create a shared experience for family members, while maintaining high levels of readiness for acute deterioration requiring operative delivery.…”

Section: Background Obstetrics and Covid-19mentioning

confidence: 99%

“…The layout and dynamics in L&D units are designed to create a shared experience for family members, while maintaining high levels of readiness for acute deterioration requiring operative delivery. Thus, labor rooms are typically in close proximity to both operating rooms and communal spaces such as the nursing stations and are subject to signi cant overlapping foot tra c (2). A single COVID-19 parturient presenting for care at L&D units would pose a considerable risk of viral exposure and spread to other healthcare workers and possibly even other patients, in particular if they required an emergency cesarean delivery.…”

Section: Background Obstetrics and Covid-19mentioning

confidence: 99%

“…We combined these recommendations with our own organization's newly designed perioperative work ows for COVID-19 patients to create the L&D work ow for the COVID-19 parturient requiring perioperative care. It was produced as a single page document, formatted as a sequential checklist with the intention to be used in real time as a cognitive aid (2). The checklist was an intentional design decision, documented as an effective means of detailing sequential steps in care (21); it also t in with existing local practice of checklist use for pre-operative brie ngs for all patients going to the operating room on L&D. The intended users of the checklist were staff from nursing, maternal-fetal-medicine, obstetrics, anesthesia and neonatology.…”

Section: Innovation Designmentioning

confidence: 99%

“…Implementation of this innovation took place through a process of rapid cycling over a period of 2 weeks (22)(23)(24), described in detail by Li et al, 2020 (2). The initial work ow draft was disseminated among clinical leaders and stakeholders and underwent one cycle of cognitive redesign.…”

Section: Implementation Of Work Ow Changementioning

confidence: 99%

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Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Zucco

Levy

et al. 2021

Preprint

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Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe factors which influenced rapid cycle implementation a novel comprehensive perioperative checklist for care of the COVID-19 parturient.Methods: Implementation of a novel workflow for the COVID-19 parturient requiring perioperative care was accomplished through rapid cycling, debriefing and on-site walkthroughs. Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% workflow checklist utilization). Retrospective analysis of the factors influencing implementation was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Analysis of factors influencing implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting, and characteristic of individuals (external pressures, baseline culture, and personal attributes) were perceived to act as early barriers. Constructs such as communication culture and learning climate, shifted in influence over time.Conclusion: We describe the influential factors of implementing a novel comprehensive obstetric workflow for care of the COVID-19 perioperative parturient during the first surge of the pandemic using the CFIR framework. Early workflow adoption was facilitated primarily by two domains, namely thoughtful innovation design and careful implementation planning in the setting of a long-standing culture of improvement. Factors initially assessed as barriers such as communication, culture and learning climate, transitioned into facilitators once a perceived benefit was experienced by healthcare teams. These results provide important information for the implementation of rapid change during a time of crisis.

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Urgent Cesarean Delivery in COVID-19 Patients: Simulation, Skill, and Triage

Malvasi,

Campanelli,

Liaci

et al. 2023

Practical Guide to Simulation in Delivery Room Emergencies

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Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 11 publications

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

Urgent Cesarean Delivery in COVID-19 Patients: Simulation, Skill, and Triage

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