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Timeliness of Indicated & Urgent Cesarean Delivery (CD): An Inter-Professional Approach to Reducing Decision-to-In OR Time Intervals
Abstract Number: S 29
Abstract Type: Original Research
Background: A 11-15% annual delivery growth (2,773 in 2008 to 4,510 in 2012), a 30-35% CD rate, and limited space (2 ORs) affect our unit’s CD case efficiency. In late 2011, our inter-professional OB QI Committee noted long delays in starting indicated CDs. A CD timeliness audit form was completed for all CDs beginning Feb 2012. Some decision-to-OR entry intervals (D-O) were excessively long for “indicated” (needing early delivery, no physiologic compromise) and “urgent” (non-life threatening compromise) categories (1).Beginning in July, interventions were implemented to shorten D-O: establish timeliness goals (<60min D-O for indicated) (Jul), emphasize contingency plans for a 3rd stat CD (Jul), direct OB-to-Anesthesia attending notification of CD decision and notification documentation (Oct). We studied the effect on CD start timeliness.
Methods: IRB approval. Anesthesia record & OB QI databases were used to record CD decision and in OR times for all indicated & urgent CDs, Feb to Dec 2012. These 2 classes were combined owing to their combined designation during prospective data collection in Feb-Jul, and difficulty distinguishing between them in the database.2 D-O was calculated for each case. Descriptive statistics were calculated, as was the percentage of cases with D-O >60 min (the “indicated” target goal). Monthly D-O means were compared with one-way ANOVA, followed by multiple comparisons posttest for linear trend. P<0.05 was considered significant.
Results: Mean & SD of D-O intervals steadily decreased over time [figure]. The proportion of D-O intervals exceeding 60 min steadily decreased: Jun 36.5%, Jul 38.5%, Aug 28.8%, Sep 29.1%, Oct 20.5%, Nov 21.4%, Dec 19.4%.
Discussion: Measurement & analysis of D-O intervals, plus collaborative interventions to enhance timeliness & safety, reduced D-O intervals within months. Dramatic improvement followed introduction of direct OB-to-anesthesiologist notification and its documentation. The study is limited by inability to separate indicated from urgent in the period Feb-Jul. However, this is not unexpected (2), it allowed data to be treated uniformly, and was consistent with the goal to improve start timeliness of both categories. Further detailed study will examine intra-operative intervals (in OR, anesthesia ready, incision, delivery, out of OR) to further enhance efficiency.
Ref: 1) Lucas D. J Roy Soc Med 2000;93:346-50. 2) vanDillen J. Int J Gynecol Obstet 2009;107:16-8