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The clinical outcomes following the introduction of an emergency cascade bleep system for emergency cesarean sections
Abstract Number: F-60
Abstract Type: Original Research
A single cascade bleep system was introduced at University College London Hospital (UCLH) in November 2012 to inform all team members simultaneously that an emergency cesarean delivery (CD) was about to occur. Prior to this, all team members had to be contacted individually by the labor ward coordinator. A senior anesthesiologist would only attend the CD if specifically called by the anesthetic resident on labor ward. We wanted to review the clinical outcomes for staffing and fetal wellbeing following the introduction of the bleep.
A 22 month (11 month pre bleep and 11 month post bleep introduction) retrospective review of women undergoing emergency CD under general anesthesia (GA) was performed. Information collected included the grade of the most senior anesthesiologist present, decision to delivery interval (DDI) according to national audit standards (1) and umbilical cord gases. We excluded any failed spinals and epidural top ups as these themselves would delay the DDI, and also any parturients given a primary regional technique as the true urgency of the CD may be called into question. Statistical analysis included Mann-Whitney U and Student t tests.
51 cases were identified and analysed. There was a significant increase in the attendance of senior anesthsiologists after the introduction of the bleep (P=0.014), especially out of hours. Although there was a non significant reduction in the DDI, there was a significant improvement in umbilical artery (UA) pH.
We believe that the single emergency cascade bleep system produced a better co-ordinated response to emergency CD. This led to a modest reduction in DDI, and perhaps the significant improvement in the UApH. Improved communication amongst the multidisciplinary team members secondary to the bleep system resulted in more senior anesthesiologists being present without the need to call them separately. This senior experience may have contributed to the reduction in DDI and improved fetal outcomes. The impact of other confounding factors such as changes in obstetric practices and the presence of an obstetric attending was not analysed in this study.
(1) National Institute for Health and Care Excellence (2011) Caesarean section CG132. London: National Institute for Health and Care Excellence