TY - JOUR
T1 - Development and pilot testing of a context-relevant safe anesthesia checklist for cesarean delivery in East Africa
AU - Alexander, Louise A.
AU - Newton, Mark W.
AU - McEvoy, Kendall G.
AU - Newton, Micah J.
AU - Mungai, Mary
AU - Dimiceli-Zsigmond, Mary
AU - Sileshi, Bantayehu
AU - Watkins, Scott C.
AU - McEvoy, Matthew D.
N1 - Funding Information:
Funding: GE Foundation developing health globally program through Improving Perioperative & Anesthesia Care & Training in Africa grant, Boston, MA.
Funding Information:
In conclusion, we report on the successful creation and initial testing of a checklist for safe CD in SSA. Ongoing efforts are underway to complete checklist implementation. Future research should reproduce this work for other priorities for safe surgery and anesthesia outlined in the DCP, third edition, and supported by the Lancet Commission on
Publisher Copyright:
© 2018 International Anesthesia Research Society
PY - 2019
Y1 - 2019
N2 - BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries. METHODS: Accordingly, with input from East African health care professionals, we created a context-relevant obstetric anesthesia checklist for cesarean delivery. Second, clinical observations were performed to assess in a real-world setting. Third, a pilot testing of the cognitive aid was undertaken. RESULTS: Clinical observation data highlighted significant deficiencies in the management of obstetric emergencies. The use of the cesarean delivery checklist during simulations of peripartum hemorrhage and preeclampsia showed significant improvement in the percentage of completed actions (pretraining 23% ± 6% for preeclampsia and 22% ± 13% for peripartum hemorrhage, posttraining 75% ± 9% for preeclampsia, and 69% ± 9% for peripartum hemorrhage [P <.0001, both scenarios; data as mean ± standard deviation]). CONCLUSIONS: We developed, evaluated, and begun implementation of a context-relevant checklist for the management of obstetric crisis in low- and middle-income countries. We demonstrated not only the need for this tool in a real-world setting but also confirmed its potential efficacy through a pilot simulation study.
AB - BACKGROUND: Maternal mortality rate in developing countries is 20 times higher than in developed countries. Detailed reports surrounding maternal deaths have noted an association between substandard management during emergency events and death. In parallel with these findings, there is increasing evidence for cognitive aids as a means to prevent errors during perioperative crises. However, previously published findings are not directly applicable to cesarean delivery in low-income settings. Our hypothesis was that the use of obstetric anesthesia checklists in the management of high-fidelity simulated obstetrical emergency scenarios would improve adherence to best practice guidelines in low- and middle-income countries. METHODS: Accordingly, with input from East African health care professionals, we created a context-relevant obstetric anesthesia checklist for cesarean delivery. Second, clinical observations were performed to assess in a real-world setting. Third, a pilot testing of the cognitive aid was undertaken. RESULTS: Clinical observation data highlighted significant deficiencies in the management of obstetric emergencies. The use of the cesarean delivery checklist during simulations of peripartum hemorrhage and preeclampsia showed significant improvement in the percentage of completed actions (pretraining 23% ± 6% for preeclampsia and 22% ± 13% for peripartum hemorrhage, posttraining 75% ± 9% for preeclampsia, and 69% ± 9% for peripartum hemorrhage [P <.0001, both scenarios; data as mean ± standard deviation]). CONCLUSIONS: We developed, evaluated, and begun implementation of a context-relevant checklist for the management of obstetric crisis in low- and middle-income countries. We demonstrated not only the need for this tool in a real-world setting but also confirmed its potential efficacy through a pilot simulation study.
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U2 - 10.1213/ANE.0000000000003874
DO - 10.1213/ANE.0000000000003874
M3 - Article
C2 - 30379674
AN - SCOPUS:85064989958
SN - 0003-2999
VL - 128
SP - 993
EP - 998
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 5
ER -