Nurses OK'd to begin rolling on C-sections

The length of time it takes to begin an emergency cesarean is a well-known malpractice risk, and one hospital system has cut the percentage of emergency cesareans that take more than 30 minutes to begin by nearly two-thirds.

The guidelines calling for a maximum of 30 minutes have in fact become a bright line determinant of liability in court, notes Janey Myers, BSN, assistant vice president of the HCA perinatal safety initiative. If it took 31 minutes or longer from the time an emergency was declared to the first incision, a jury usually will find the hospital liable — even though the professional guidelines were never meant to be so rigid.

13% miss 30-minute deadline

HCA found that about 13% of all emergency cesareans were not performed within the 30 minute deadline, Myers says. Further study of the issue revealed that the causes were tied to an inability to get the team together quickly and an inconsistent definition of "emergency."

One problem was that in a typical scenario, a nurse would call the obstetrician at home in the middle of the night and say that she thinks an emergency cesarean is needed. The doctor then has 20 or 30 minutes, by most hospital requirements, to get to the hospital and evaluate the patient. During that time, nothing is done to move toward the emergency cesarean because the doctor has not officially declared the emergency. Then when the doctor gets there and agrees that an emergency surgery is needed, it can take another half-hour or more to assemble everyone and begin the procedure.

HCA changed all that by declaring that labor and delivery nurses can declare the emergency on their own and are empowered to deploy the emergency cesarean team and begin the operating room setup.

"When the physician gets there, everyone is ready to rock and roll and get that baby out," she explains. "The doctor still has to confirm that the emergency procedure is necessary, and if he or she does, then you've saved a half-hour of valuable time. If not, we're out some supplies and we've inconvenienced a few members of the team, but it's well worth it to avoid something that can be a life-threatening event for either mom or baby."

As a result of the changes at HCA, the window of time from when the nurse suspects an emergency to surgery has been cut from nearly an hour to 20 minutes in 90% of the cases. The percentage of emergency cesareans that take more than 30 minutes to begin has been cut from 6.9% in 2002 to 2.4% in 2004.

Any emergency cesarean that takes more than 30 minutes is thoroughly investigated to determine why and how those causes can be addressed.