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Does the Time of Day Affect the Decision to Incision Interval for Cesarean Section?
Abstract Number: F-21
Abstract Type: Original Research
Introduction: Preparation for non-elective cesarean section (CS) requires numerous steps and levels of coordination across a several disciplines. During the day, different resources may be available to perform and coordinate these steps when compared to resources available at night. While in an emergency all resources are likely to be mobilized regardless of the time of day, for urgent, but not emergency CS, a difference in resources might affect the time interval from decision to skin incision. Although many obstetricians use a guideline of 30 minutes for decision to incision interval (DII) in emergency CS, no such guideline is widely accepted for urgent, non-emergency CS. We questioned therefore whether time of day affects what we considered to be a reasonable and an attainable goal of a 60 minute DII for urgent CS at an academic institution.
Methods: Data were collected from electronic obstetric and anesthesia records for all non-elective cesarean deliveries from September 2013- January 2014. We eliminated true “stat” CS (total of 12) as defined by the obstetrician. DII was calculated. The time of day during which the case was performed was categorized as either Day or Night shift based upon the time of anesthesia staff shift change. For the Day vs. Night comparison, we estimated the difference in the fraction under 60 minutes Day vs. Night and computed confidence intervals under a binomial distribution.
Results: Total number of urgent CSs included 30 during the Day and 35 at Night. The fractions under 60 minutes Day vs. Night were 0.73 vs. 0.46, with an estimated difference of 0.28 (95% C.I. 0.05 to 0.50), Figure.
Discussion: A smaller proportion of urgent CS performed at night had a DII below 60 minutes. The reasons for this are likely multifactorial. Potential contributing factors include reduced staffing at night, increased length of time to obtain lab results and relative differences in skill levels of respective providers (both nurses and physicians) working certain shifts. This finding is unlikely to be due to differences in patient population, as patients present to Labor and Delivery at random times. As we continue to collect data, we anticipate that we will find other factors that contribute to a prolonged DII. Although a 60 minute DII appears to be attainable, the clinical benefit of a targeted DII for urgent CS requires further investigation.