Journal of Anesthesia and Surgery
A Category one Caesarean section process at an Australian tertiary obstetric hospital: Planning to reduce decision to delivery time.
1Obstetric Services, University of Queensland School of Medicine, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
2Midwifery Services, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
3Neonatal Services, Royal Brisbane & Women’s Hospital, Brisbane, Queensland, Australia
4Queensland Institute of Medical Research, Brisbane, Queensland, Australia
5Queensland Children’s Medical Research Institute, University of Queensland Department of Paediatrics & Child Health, Royal Children’s Hospital, Brisbane, Queensland, Australia
Matthew Smith, University of Queensland School of Medicine, Royal Brisbane & Women\'s Hospital, Brisbane, Queensland, Australia-4006; E-mail: firstname.lastname@example.org
Smith, M., et al. A Category One Caesarean Section Process at an Australian Tertiary Obstetric Hospital: Planning to Reduce Decision to Delivery Time (2014) J Anesth Surg 1(1): 15-19.
© 2014 Smith M. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
KeywordsEmergency Caesarean section; Category-1 Caesarean section; Decision to delivery; Decision to incision
Objective: To standardise emergency response processes to life threatening maternal and fetal situations requiring activation of a category one Caesarean section (C1CS), with the aim of reducing decision to incision (D-I) and decision to delivery (D-D) times.
Design: A prospective observational study following the introduction of a streamlined C1CS process.
Setting: A tertiary public obstetric hospital.
Population: All women who had a C1CS process activated over a 14 month period.
Methods: Data were collected prospectively on a newly developed C1CSResponse Management Plan with documentation of D-I and D-D times for multiple variables. Main outcome measures D-I and D-D times.
Results: The median D-I was 11 minutes (interquartile range (IR): 7 minutes). 83% (68/82) of calls which proceeded to C1CS had D-I within 15 minutes. The median D-D was 17 minutes (IR: 9 minutes). 76% (62/82) of calls, which proceeded to C1CS, had D-D within 20 minutes and 96% within 30 minutes. Factors which significantly decreased D-I and D-D (p<0.05) included: taking verbal rather than written consent, not performing bladder catheterisation, not performing pubic clipping, and not changing women into theatre attire. Seniority of the surgeon did not affect times.
Conclusions: A streamlined C1CS process can achieve D-I and D-D times well within expected international standards.