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The Effect of Resource Improvement on the Decision-to-Delivery and Post-Anesthesia Care Unit Time Intervals in a Low-Resource Setting
Abstract Number: F 36
Abstract Type: Original Research
Introduction: Limited resources in developing countries hamper the ability to conduct prompt emergency cesarean section (CS) within the 30-minute benchmark for the decision-to-delivery interval (DDI) upheld by most developed countries.1,2,3 Delay may culminate in maternal and fetal complications including death.3 The purpose of this study was to compare DDI and post-anesthesia care unit (PACU) times before and after a dedicated obstetric operating room was created at Ridge Regional Hospital in Accra, Ghana.
Methods: The study compares patients undergoing CS in Aug-Sept 2011 (before) and Aug-Sept 2012 (after) the addition of the new OR facility opened on March 1, 2012. The following time periods were recorded for each patient: T1 (decision), T2 (arrival to OR holding room), T3 (anesthesia start), T4 (delivery), T5 (PACU arrival), T6 (PACU discharge). Data was also stratified by urgency (emergent vs. elective CS); day of the week (weekday vs. weekend), and work shift (day shift vs. night shift). Maternal and neonatal outcomes were assessed. The DDI is defined as the interval between T1 and T4 and PACU time as the interval between T5 and T6. Time intervals before and after the new OR were compared using appropriate non-parametric statistics. NICU stay was evaluated with chi-square.
Results: Of 1,129 parturients, 559 (49.5%) had CS before and 570 (50.5%) after OR completion. Patient characteristics were similar in age, parity, gestational age and CS urgency. DDI decreased by 25% (overall) and 22% (emergency) and PACU time decreased by 46% (Table). The DDI was shorter at night for both periods, with an avg of 6 CS/day and 4 CS/night. The DDI was shorter on weekend days in 2011, with an avg of 9-10 CS/weekday or weekend day. There were no maternal deaths in 2011 but 3 deaths in 2012. Only 2 (0.5%) and 9 (2.2%) of emergency CS were conducted within 60 min, for 2011 and 2012 periods, respectively; and only one was done within 30 min in 2012.
Conclusion: A dedicated maternity OR facilitated process improvement. Waiting times decreased and fewer newborns were in the NICU. Adhering to a 30-minute DDI benchmark, however, may be impractical in resource-poor settings. Further investigation and quality improvement efforts are required to delineate these gains and to make further progress in the reduction of delays in emergency obstetric care.
References: 1Obstet Gynecol 2006;108:6-11, 2J Obstet Gynaecol 2006; 26(4):307-10, 3Int J Gyn Obstet 2012;116:17-21.