Authors (including presenting author) :
Yuen MSY (1), Choi YF (1), Wong D (2), Yip MYC (2), Chan CMV (3), Chan LW (1), Kwok FY (1), Siu YC (1)
Affiliation :
(1) Department of Accident and Emergency, (2) Department of Obstetrics and Gynecology, (3) Department of Pediatric and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
Introduction: Emergency delivery is not uncommon in Accident and Emergency Department (A&E), however maternal and neonatal resuscitation are uncommon. Successful resuscitation efforts depend on critical actions that occur in rapid succession to maximize the chance of survival. Effective and timely resuscitation could improve maternal and neonatal outcome. There was one case of maternal resuscitation in A&E where perimortem cesarean was performed within 4 minutes’ time and neonatal resuscitation was carried out in September 2020, mum was survived.
Objectives :
Objective: To report on the implementation of improvement measures in A&E
Methodology :
Method: Evaluation meeting of perimortem case was held with Department of A&E, Obstetrics & Gynecology (O&G), Pediatrics and Adolescent Medicine (Pedi), Anesthesiology (Anae) and Intensive Care (ICU) week after, the guidelines of maternal and neonatal resuscitation in PYNEH were revised, multidisciplinary guidelines of maternal resuscitation was proposed and written. Pregnant woman with gestation after 20 weeks or gravid uterine size at umbilical level or above, with witness or un-witness maternal cardiac arrest would trigger the guidelines in PYNEH, where maternal resuscitation, delivery, neonatal resuscitation, transfer and continuity of care would be done by designated specialties. To prepare for the above implementation, staff education was duly carried out. Onsite Trio Simulation and Drill of Emergency Delivery and Neonatal Resuscitation was organized and stakeholders (A&E, O&G, Pedi, Anae, Labour) were invited to participate. Perimortem Cesarean Section Set in A&E was simplified with O&G Team, Manual uterine displacement was proposed to all, Activation call to Telephone Operator was simplified and Cue Card was displayed at Resuscitation Room, Specialists of clinical departments and Cluster Resuscitation Committee devised the guidelines, opinions were sought from all clinical departments and handover mechanism of patients were enhanced. Barriers to implementation were overcome at the Trio Simulation and Drill in A&E and prospective audit carried out in implementation period.
Result & Outcome :
Results: Although there was nil pregnant woman that triggered the guidelines in A&E from January 1st to December 31st 2022, there were three triggered at Trio Simulation and Drill in February and October 2021 and December 2022 respectively, which Perimortem Cesarean were performed within 5-6 minutes in A&E and Neonatal Resuscitation were carried out. The overall compliance to new guidelines were 100%. Workload were regarded acceptable from staffs’ surveys. Implementation were smooth and new measures were welcomed by clinical departments. Conclusion: Through multidisciplinary collaboration, the improvement measures were feasible and resulted in significant improvement in overall management of maternal and neonatal resuscitation at the Trio Simulation and Drill in A&E.
