Trauma Caesarean Section – An Example of Excellent Interdisciplinary Working

Dr Anne Bailey, ST4 Anaesthetics, Dr Megan Harty, CT1 Anaesthetics, Dr Nidhi Gupta, Consultant Anaesthetist
Craigavon Area Hospital, Southern Health and Social Care Trust.

 

Learning objectives: 

Discuss the importance of the interdisciplinary  team                                                               

Recognise the importance of human factors in emergency situations                                

Highlight models used in healthcare to promote patient safety

 

Case summary:

Demographics                                                                                                                                           

32 years old                                                                                                                                              

31+4 weeks gestation                                                                                                               

Passenger in high-speed road traffic collision

 

Initial Anaesthetic Assessment                                                                                                            

Pre-alert trauma call to emergency department                                                                     

Primary assessment: patient stable and cardiotocography (CTG) normal                                

Investigations: Computed tomography (CT) scan with prompt reporting showing left sided pneumothorax with small volume haemothorax, 1st-9th left-sided rib fractures with evidence of flail segment and bilateral clavicular fractures                                                                                                              

Referred to intensive care team for assessment and monitoring                                   

Cardiothoracic advice

 

Ongoing Anaesthetic Management                                                                                        

Category 1 caesarean section  due to abnormal CTG                                                               

Patient transferred to obstetric theatre                                                                                       

Arterial line for invasive monitoring and blood gas sampling                                                                             

Analgesia- ketamine titrated to maximum 30mg                                                                                    

Spinal anaesthesia- 2.5ml 0.5% heavy bupivacaine and 250micrograms diamorphine        

Blood loss 1000ml- no products transfused

 

Post-operative Management                                                                                                      

Thoracic epidural inserted for analgesia                                                                                          

Chest drain inserted for a persistent pneumothorax                                                                  

Intensive care unit for three days                                                                                                      

Day 24 underwent video-assisted thoracoscopic surgery for persistent loculated empyema

 

Discharge and Follow-up                                                                                                      

Discharged home                                                                                                                                        

Both mother and baby remain well five months following the event                                   

Ongoing counselling and perinatal mental health input

 

Discussion:

Obstetric anaesthesia is complex with two patients to care for; increased morbidity and mortality compared with the non-pregnant population of the same age; and the potential for rapidly progressive and severe adverse events and complications (1). Patient safety in obstetric anaesthesia requires a multidisciplinary and multifactorial approach (2).

Human factors is the evidence based scientific discipline concerned with the understanding of interactions among humans and the system they work within. It applies theory, principles, data and methods to system design to explore and optimise human well-being and overall system performance. Human factors includes non-technical skills such as communication and teamwork in the context of the wider system design (3).

System Engineering Initative for Patient Safety (SEIPS) framework (4):

 

Conclusion:

This case reflects the complex and high-stakes situations faced by healthcare workers as part of the wider healthcare system. It is an example of how the  interdisciplinary team, as the ‘people’, play a key role in safety and quality care and ultimately a positive outcome for the patient. Human factors, particularly excellent communication, prompt decision making, and teamwork saved the lives of this patient and her baby.