A program that improves decision-to-incision time

Cesarean delivery (CD) efficiency, measured by the time from decision-to-incision, significantly improved over 2 years with the implementation of a quality improvement program, according to research published in the March issue of Obstetrics and Gynecology.

Roberta Haynes de Regt, MD, of the Evergreen Hospital Medical Center in Kirkland, WA, and colleagues assessed the decision-to-incision time for unscheduled CD procedures, which were ordered for various indications. Those procedures that were initiated within 30 minutes of the decision to proceed were considered efficient. The investigators compared delivery efficiency between 2004 and 2006, after a quality improvement program was initiated in 2004 at a community hospital.

The efficiency rate of unscheduled CDs significantly improved during the study period (from 36%-59%), the researchers report. Unscheduled deliveries classified as an emergency procedure improved (67%-84%), as did those for patients with an indication of failure to progress (33% to 54%), the investigators found. Cesareans occurring for an indication classified as “other” (including breech, placental abruption, and multiple gestation) were among the most improved (18%-49%), the report indicates.

“Cesarean delivery efficiency varied by indication, but a data-driven hospital-based initiative successfully improved efficiency over time,” the authors conclude. “Indication-based standards that address an institution's staff and structural capacity are needed to evaluate time from decision to incision.”

de Regt RH, Marks K, Joseph DL, et al. Time from decision to incision for cesarean deliveries at a community hospital. Obstet Gynecol. 2009;113:625-629. doi: 0.1097/AOG.0b013e31819970b8.