1. Relocation of ORC to OR2 Svetlana Schopp, RN, CNL Student
University of San Francisco
November 2014

2. Specific Aim Relocate ORC to OR2 on September 3rd, 2014
Maintain safety & quality of patient care in new location
Through effective interdisciplinary communication & collaboration
Create process standardization

3. Background Measure C Women and Family Center GO bond, $98.5M
Passed in 2007
To fund upgrades for campus
Women and Family Center
New construction
Seismically compliant
Planned completion 2016

4. Supportive Data
FMEA – proactive identification of process failures (Appendix A)
Extended transport time
Communication among clinicians
STAT cesarean sections (C/S)
Staff education for STAT C/S
Process Flow Charts
STAT C/S during normal business hours (Appendix B)
STAT C/S after hours, on weekends & holidays (Appendix C)
Mobilizing patient to OR for C/S (Appendix D)
C/S Process Algorithm (Appendix E)

5. Microsystem Status Relative to the Project
SWOT Analysis (Appendix F)
Internal Factors
Strengths: skilled staff, continuity of care for C/S patients
Weaknesses: longer pt transport time, unfamiliar location for OB staff
External Factors
Opportunities: improve communication, develop checklists for standardization, increase efficiencies
Threats: loss of an OR for 2 years

6. Literature Search Strategies – based on highest severity of outcome
Decision to incision
STAT cesarean section
Standards & recommendations
Databases
CINHAL Complete
PubMed
Scopus
EBSCOhost

7. Summary of Evidence Mooney, Ogrinc, & Steadman (2007)
Effective teamwork & communication to shorten decision to incision
deRegt, Marks, Joseph, & Malmgren (2009)
Collaborative interdisciplinary approach & teamwork to shorten decision to incision
Bloom et al. (2006)
Use sound clinical judgment to establish urgency in emergency situations
Nielsen et al. (2007)
Teamwork training shortens decision to incision in emergency

8. Apply the Evidence Maternal & Neonatal Safety
Effective communication/collaboration
Effective teamwork
Sound clinical judgment
EBP

9. Patients Stakeholders Anesthesiologists OB, OR, PAAS staff
Obstetricians
Pediatricians
RTs
Patients
Definition of a stakeholder (engage audience)
Who are the stakeholders in this process? (engage audience)
Most important stakeholders? (patients) – (engage audience)
SPD staff
EVS staff
PCTs

10. Business Case
Patient transport to and from OR2: $10,271.2 (Appendix H)
Potential loss of OR revenue at $33.12 per minute
Potential for $$$ liability w/change in location
Cost of PPH carts & extra C/S instrument set $6,000
Cost of labor for CNL $16,000 (based on 220 hours)

11. Timeline

12. Supportive Theory Unfreezing Changing Refreezing
Kurt Lewin’s Change Theory (1951)
To become motivated to change
Unfreezing
What needs to be changed
Changing
To make changes permanent
Refreezing

13. Results/Outcomes As of November 16th, 2014: 26 C/S, 10 elective
Have maintained safety & quality of patient care
Delays on elective C/S
Suction for newborn resuscitation
Support person waiting area
PPH & operative delivery

14. Recommendations Continue Plan-Do-Study-Act cycles
Adjust practices as needed
Improve efficiencies in elective C/S
Standardize PPH & operative delivery processes

15. Clinical Nurse Leader (CNL) Role
Master’s prepared nurse
Not advanced practice
Able to practice in any healthcare setting
Focuses on:
Quality improvement strategies
Outcome based practice
Interprofessional communication
Care coordination
Toolkit: FMEA, SWOT, PDSA, EBP, Summary Brief

17. Thank you!