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Grand Rounds: Ob Team Stat: Developing a better L&D rapid response team

The recommended 30 minute "decision to incision" response time to obstetric emergency is not adequate to prevent adverse outcomes in certain scenarios. Improving on the current sequential team activation response to emergency, Allan Bombard, M.D., along with Karyn Almyrde, BSN and Val Catanzarite, MD Phd, developed the "Ob Team Stat" rapid response team. They utilized the Lockheed Martin "Skunk Works" approach to team project development, often employed in the business world. "Ob Team Stat" employs a simultaneous team activation approach to obstetric emergency. The system is activated by any team member, who simultaneously overhead pages and beeps the L&D charge nurse, in-house obstetrician, anesthesiologist, OR surgical team, neonatalogist, and NICU team.

After approval for a new hospital procedure, the team concept was discussed and refined through the Hospital Committees of all the team members and those they would interact with, and then put into operation within a week. Review of six months of data after "Ob Stat Team" introduction revealed the time from team activation to delivery had a mean of 10.9+/- 4.0 minutes, with a range of four to 19 minutes. In a team activation for uterine rupture during a VBAC, delivery was within six minutes and 30 seconds from onset of bradycardia. A different approach to problem solving by a small team, followed by continual monitoring and adaptation of the "Ob Stat Team" dramatically improved response times to obstetric emergencies compared with other institutions (Catanzarite, Almryde, Bombard 2007).