Response to an Emergency Cesarean Delivery (ECD) at rural hospitals is complicated not only by inefficiencies in monitoring and early detection of fetal and/or maternal distress during labor, but by the conditions of the rural settin. Many rural hospitals lack the resources to have round-the-clock surgical staff and operating rooms reserved for cesarean delivery. Despite the availability of superior inexpensive technologies, an ECD team is often summoned to surgery using inadequate pager and telephone methods. People who must, or choose to, live in rural areas are no less deserving of timely and effective emergency obstetrical care than those in large cities. The Agency for Healthcare Research and Quality defines failure to Rescue, the lack of effectiveness and timeliness of actions taken once early medical complications are recognized, as one of the measures of quality of care. Delays in response as well as errors and omissions can lead to failures to rescue the fetus and mother, leading to increased mortality and neonatal morbidity. Based on preliminary work with an existing prototype, Bauer Labs proposes to test the feasibility and to conduct further research and the development of an intelligent e-summoning and enterprise management system aimed at coordinating the effective and timely assembly of the ECD team and the preparation of patients and operating room according to best practice guidelines. Our system has the capability to not only summon the surgical team, but also to facilitate communication among team members, coordinate team decisions, standardize preparation activities, and keep personnel informed of the status of the team, the patient, and the operating room. Furthermore, our system provides an interface between the electronic medical record (EMR), and commercially available asset management and patient tracking solutions aimed at providing needed decision and coordination support. In phase 1, we propose to: A) Fully evaluate the effectiveness and operability of the existing prototype under a simulated clinical ECD and gather input from users on further system development. B) Build a robust and reliable second generation prototype meeting the technical and operability requirements identified in the previous evaluation. C) Develop the methods to integrate patient medical information from the EMR into the summoning system using Bauer Lab's proprietary multi-agent system technology. D) Develop the interface between our system with off-the-shelf asset management and patient tracking solutions. E) Evaluate the effectiveness and operability of our system in reducing errors, increasing communication, and meeting the 30-minute "decision-to-incision" interval target during total team and hospital ECD simulation trials. The ultimate goal o this project is to demonstrate the technical feasibility of using intelligent and integrated healthcare delivery management systems based on Bauer Lab's proprietary multi-agent system technology to prevent failures to rescue by intelligently integrating clinical, logistical, and operational information, and presenting it to the care team in a manner that integrates non-intrusively with the clinical workflow.
The ability to capture detailed knowledge about clinical processes and use it in real-time to guide procedures, provide decision support, capture and display patient data, and alert the medical team to critical information will be a major improvement in the capabilities of the medical system, leading to the reduction of delays, omissions, and other errors during emergency surgical interventions. These improvements will reduce the time from decision-to-incision in Emergency Cesarean Delivery and reduce the likelihood of mishaps resulting in patient (mother and fetus) morbidity and mortality.