Nottingham Obstetric and Anaesthetic Time points for Surgery (NOATS):
Using a modified Delphi process to define a standard for time points in obstetric surgery.
D Sinha1, A Davey2, A Banks3. Nottingham University Hospitals NHS Trust
1ST3 Anaesthetics, 2SPR Anaesthetics, 3Consultant in Anaesthetics. Department of Anaesthesia, City Campus. Nottingham University Hospitals NHS Trust, Nottingham, UK
Time points including arrival time, anaesthetic start and finish times are routinely recorded in obstetric theatre by theatre staff. Accurate time points are crucial in time critical operations where they are of medico-legal importance. However, no time point definitions exist which can lead to confusion and lack of time point reliability.
This variability had been noted in our theatres, where recorded time points did not appear to always reflect clinical reality so a piece of work was conducted out to look at this issue.
An initial free text questionnaire was carried out of all members of the multi-disciplinary maternity theatre team. This included anaesthetists, obstetricians, midwives, operating department practitioners, scrub nurses and support workers.
Results were collated and a 2 round modified Delphi method was used to establish consensus definitions for the commonly recorded time points. Two expert panels – one for anaesthetic time points and one for obstetric time points were recruited.
Results of free text survey
86 responses to the initial free text survey were received. This showed that there was great disparity in the individual definitions for each time point, an example of the variation is shown below. The subsequent modified Delphi method produced consensus definitions within 2 rounds.
Process after initial free text survey
Consensus defintions were achieved with two rounds of a modified Delphi process.
Summary and recommendations
• We have produced consensus based standardised time point definitions for operative obstetric cases.
• These definitions will provide medico-legal clarity and uniformity in Nottingham.
• A poster has been produced which will be displayed in all maternity theatres.
• The scheme is currently being launched.
•A local survey identified wide variation in what staff perceived each time point to mean.