Graduation Date
Summer 8-31-2025
Submission Type
Dissertation/Thesis
Degree Name
Doctor of Nurse Anesthesia Practice
Department
Doctor of Nurse Anesthesia Practice (DNAP) Program
School
School of Nursing
Keywords
rapid sequence spinal anesthesia, spinal anesthesia, emergency cesarean section, subarachnoid block, anesthesia protocol, quality improvement, decision tree
Abstract
Abstract
Background: General anesthesia (GA) for emergency cesarean sections (EmCS) poses potential risks Rapid Sequence Spinal Anesthesia (RSSA) offers a promising alternative that preserves benefits of neuraxial anesthesia while accommodating the urgency of EmCS. This quality improvement (QI) project aimed to implement and evaluate the use of RSSA at a teaching hospital, utilizing a decision-tree tool to enhance clinical efficiency and assess provider perceptions regarding its impact on airway complications and post-operative pain outcomes. Methods: A RSSA decision-making chart was developed and introduced to anesthesia providers at a teaching hospital. A total of 16 providers, including CRNAs, SRNAs, and anesthesiologists, completed a Likert-based survey evaluating familiarity, confidence, perceived safety benefits, and utility of the tool. Results: A majority (81%) agreed that RSSA reduces maternal airway risk, and the same proportion agreed it improves postoperative pain outcomes. 88% rated RSSA as a safe and effective alternative to GA, and 81% found the decision-tree helpful in guiding clinical care. Primary barriers included delays by the obstetrics team, inconsistent interprofessional communication, and limited provider buy-in. Overall satisfaction with RSSA implementation was high, with 75% rating their satisfaction as 9 or 10 out of 10. Conclusions: RSSA is perceived by providers as a safe, effective alternative to GA for EmCS and a valuable addition to obstetric anesthesia care. The decision-tree chart contributed to increased provider confidence despite limited procedural experience. These findings support broader education and structured implementation of RSSA, with future quality-improvement initiatives recommended to evaluate patient-centered outcomes and sustainability of this intervention.
Recommended Citation
Baselj, Hunter L. and Gabster, Joseph A., "Quality Improvement Initiative for Emergency Cesarean Delivery: Implementation of Rapid Sequence Spinal Anesthesia" (2025). Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts. 4.
https://dsc.duq.edu/dnap/4