title: Response times for emergency cesarean delivery: use of simulation drills to assess and improve obstetric team performance.
abstract: OBJECTIVE
  We documented time to key milestones and determined reasons for transport-related delays during simulated emergency cesarean.
  
  
  METHODS
  Prospective, observational investigation of delivery of care processes by multidisciplinary teams of obstetric providers on the labor and delivery unit at Lucile Packard Children's Hospital, Stanford, CA, USA, during 14 simulated uterine rupture scenarios. The primary outcome measure was the total time from recognition of the emergency (time zero) to that of surgical incision.
  
  
  RESULTS
  The median (interquartile range) from time zero until incision was 9 min 27 s (8:55 to 10:27 min:s).
  
  
  CONCLUSIONS
  In this series of emergency cesarean drills, our teams required approximately nine and a half minutes to move from the labor room to the nearby operating room (OR) and make the surgical incision. Multiple barriers to efficient transport were identified. This study demonstrates the utility of simulation to identify and correct institution-specific barriers that delay transport to the OR and initiation of emergency cesarean delivery.
authors.affiliation: Division of Obstetric Anesthesia, Department of Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA 94305, USA. steve.lipman@stanford.edu
authors.forename: S S
authors.initials: SS
authors.lastname: Lipman
authors.forename: B
authors.initials: B
authors.lastname: Carvalho
authors.forename: S E
authors.initials: SE
authors.lastname: Cohen
authors.forename: M L
authors.initials: ML
authors.lastname: Druzin
authors.forename: K
authors.initials: K
authors.lastname: Daniels
mesh_terms: D002585:Cesarean Section / Q000193:education* / Q000379:methods; D003696:Delivery Rooms; D004630:Emergencies; D005260:Female; D006801:Humans; D015931:Intensive Care, Neonatal / Q000379:methods / Q000592:standards; D017145:Models, Educational; D016134:Organizational Policy; D010348:Patient Care Team / Q000592:standards*; D016544:Patient Simulation; D011247:Pregnancy; D058996:Quality Improvement; D013192:Staff Development / Q000379:methods; D013647:Task Performance and Analysis; D061665:Time-to-Treatment / Q000592:standards*; D014187:Transportation of Patients / Q000379:methods / Q000592:standards; D014597:Uterine Rupture / Q000601:surgery; D000078329:Workforce