Table 1

 Summary of working group improvement efforts by phase of implementation

PhaseDate completeInterventions by working groups
Birthing centre nursesProvidersAnaesthesiaOperating room
CD, caesarean delivery; OR, operating room.
1Summer 2002• Analysed tasks• Established dedicated CD phone line• Created OB anaesthesia questionnaire• Purchased dedicated OR infant “stabilet”
• Reassigned inappropriate tasks• Programmed on-call team members into computer• Placed completed questionnaire on birthing centre• Prepare OR for “STAT” CD each evening
• Eliminated unnecessary tasks (eg transfer of patient to stretcher)• Programmed birthing centre phones with CD line on speed dial• Developed process for antenatal anaesthesia consults• Trained birthing centre nurses to check “stabilet” and OR preparedness each evening
• Organised supplies into CD kits• Instituted nightly test of system with mandatory call back requirement• Review OB high risk and VBAC lists each week
• Replaced OR checklist with CD specific checklist• Designated codes to indicate “STAT” v routine CD• Recommend CBC, type and screen on all labouring women
2Spring 2003• Used mock CDs to identify steps in routine process that could be eliminated during emergency• Developed standardised terminology• Worked with providers to develop standardised terminology• Synchronised OR clocks with birthing centre clocks
• Distributed flow charts of “STAT” process• Created standardised brief operative note• Assisted with development of “STAT” process map• Assisted with development of “STAT” process map
• Finalised “STAT” process map• Assisted with development of “STAT” process map
3Spring 2004• Participated in OR skills day and “STAT” pathway mock drills• Participated in OR “skills day” and “STAT” pathway mock drills• Participated in OR “skills day” and “STAT” pathway mock drills• Participated in OR “skills day” and “STAT” pathway mock drills
• Empowered nurses and CNMs to transport patients to OR in emergency
• Trained nurses in anaesthesia set up
• Trained nurses in OR set up