Changing Hospital Culture: Collaborative Response to Emergency Cesarean Sections

Monday, 9 November 2015: 1:45 PM

Barbara C. Schuch, MSN, RNC-OB, C-EFM
Birth Center, MacNeal Hospital, Berwyn, IL, USA
Sally M. Krempel, MSN, RNC-OB
Labor & Delivery, Macneal Hospital, Berwyn, IL, USA

“Changing Hospital Culture: Collaborative Response to Emergency Cesarean Sections”


Based upon the American College of Obstetrics and Gynecology’s (ACOG) and the American Academy of Pediatrics (AAP) recommended standard (30 minutes from decision to incision for emergency cesarean sections) the “30-minute rule,” a preliminary data review of “decision to incision” time audits, identified discrepancies in standardized communication and collaboration between medical and nursing staff.


This four part educational program aimed to change the culture and create an effective and collaborative response to emergency cesarean sections:

I-NICHD Nomenclature: Speaking a Common Language When Interpreting Fetal Heart

    Rate Tracings

II-Concepts for Teamwork Training in

     Obstetrics Background and Significance

III-Neonatal Outcomes

IV-Potential Postpartum Outcomes


Development/ Program Implementation

By integrating Kurt Lewin’s “Change Management Model,” this educational program’s aim was to change the culture and create an effective and collaborative response to emergency cesarean sections. The methodology of this interprofessional program incorporated a broad range of instruction (didactic lecture, fetal strip review & simulation). Focus was on standardized communication, interprofessional teamwork training, potential maternal/ infant outcomes and simulation of emergency cesarean section scenarios.


Evaluation/ Results/Barriers

Through implementation of this four part educational program, in conjunction with the development of departmental guidelines, ongoing data collection, and quality improvement review, this program was able to facilitate and sustain effective inter-professional collaboration and has made a significant impact on compliance with the ACOG “30-minute rule” standard, see (Table 1) Decision to Incision Data*

Barriers to sustained culture change continue to be identified through the debriefing of each individual case and addressed through the provider and nurse “peer review process.”

  •  Compliance with Standardized Nomenclature for Fetal Monitoring (NICHD language)

  •  Teamwork

  •  Following ER C/S Guidelines

  •  RN, Physician & Anesthesia Delays

    Improving patient safety and quality of care was the primary focus of the project.


    (Table 1) *2013-2014 Decision to Incision Data

    Cases which met the “30-min. Rule” standard ACOG Benchmark (% Compliance)

    *March 2013-December 2014 data, reflect post education results

      1st quarter 2013-45% compliance

    *2nd quarter 2013-72% compliance

      3rd quarter 2013-38% compliance

      4th quarter 2013-89% compliance

    1st quarter 2014-89% compliance

    2nd quarter 2014-85% compliance

    3rd quarter 2014-92% compliance

    4th quarter 2014-62% compliance