Ensuring a comparable standard of care for cesarean deliveries.

Your facility is having a baby boom. The number of cesarean births is exceeding the obstetrical unit’s capacity. Administrators want the OR to perform the overflow cases. What plans do you make for patient safety and care of both mother and newborn? The cesarean birth rate has risen by more than 25% in this decade. Cesareans accounted for 31% of births in 2006, the latest figure available from the Centers for Disease Control and Prevention. That places a strain on many obstetrical units and creates a need for closer collaboration with perioperative services. A surgical services director faced this situation recently. Her hospital, with 460 beds and 11 ORs, has a large and growing obstetrical volume. In the OB unit, cesarean births were staffed with one circulating nurse. But the director thought 2 RNs were needed: one to circulate for the mother’s surgery and the second to care for the newborn. She asked what nursing practice standards and guidelines apply, a question other OR directors may also be asking. A related and larger question: How can you help ensure a comparable standard of care throughout the organization? This is a growing need as invasive procedures expand to GI endoscopy, interventional radiology, the cath lab, and other departments. Joint Commission standard LD.04.03.07 requires that “patients with comparable needs receive the same standard of care, treatment, and services throughout the hospital.” At Yale-New Haven Hospital in New Haven, Connecticut, a collaborative task force has developed policies and procedures that apply across departments (sidebar).